Overview on Acute Poststreptococcal Glomerulonephritis in Pediatrics: A Review

Acute poststreptococcal glomerulonephritis (APSGN) is the most common kind of post-infectious glomerulonephritis and is caused by group A streptococcus (Streptococcus pyogenes). Although the prevalence of PSGN has decreased in affluent nations, non-streptococcal species are becoming more common. and it is still the major cause of glomerulonephritis in children. APSGN can manifest itself in epidemic outbreaks or clusters of instances, as well as in single persons. Epidemic outbreaks have previously been documented as a result of upper respiratory or cutaneous streptococcal infections in various parts of the world. In developed nations, APSGN is now mostly a disease of the elderly, who are more likely to have disabling illnesses such as cancer, alcoholism, or diabetes. Children between the ages of 3 and 12 (with a peak incidence between the ages of 5 and 6 years) and seniors over the age of 60 are the most commonly affected. The pathophysiology of APSGN is complicated by inflammation. (APSGN) often occurs one to two weeks after a throat infection and three to five weeks after a skin infection. Hematuria, edoema, azotemia, and hypertension are the most common clinical signs. Loop or thiazide diuretics, are the most effective therapy for hypertension and edoema in PSGN. In this review we’ll be looking at the disease causes, epidemiology, presentation and treatment.

Infekt-assoziierte Glomerulonephritiden

Glomerulonephritis, secondary to bacterial, or, more rarely, viral or parasitic infections, is called infection-associated. The epidemiology of infection-associated glomerulonephritis has changed in recent decades. For a long time, the classic form has been acute poststreptococcal glomerulonephritis (APGN), but in developed countries its incidence has declined sharply. However, there is an increase in staphylococcal associated glomerulonephritis (SAGN). The clinical manifestations of APGN and SAGN are different: APGN typically presents with a glomerulonephritis after an infectious latency period (post-infectious), while SAGN typically shows an immune complex glomerulonephritis concomitant with infection (para-infectious). SAGN often presents with an occult infections in older patients with multiple comorbidities.

Posterior Reversible Encephalopathy Syndrome in an Adolescent with Acute Poststreptococcal Glomerulonephritis

Posterior reversible encephalopathy syndrome (PRES) is a rare but severe complication of acute poststreptococcal glomerulonephritis (APSGN) in children. A 13-year old boy was diagnosed with APSGN based on clinical, laboratory, and renal biopsy findings. On the third hospital day, his blood pressure (BP) was 130/80 mm Hg on antihypertensive and diuretic treatment. He then developed confusion, blurry vision, and changes in speech and behavior. Over the next few hours, his BP increased to 160/90 to 170/90 mm Hg (99th percentile, 135/90 mm Hg). Magnetic resonance imaging of the brain revealed prominent hyperintensities in the right temporal, right temporo-occipital, and right parieto-occipital gray, and white matter on T2-weighted and fluid-attenuated inversion recovery images, compatible with PRES (posterior reversible encephalopathy syndrome). Electroencephalography showed generalized epileptiform activity. After treatment with anticonvulsant and additional antihypertensive medications, his clinical symptoms and neuroimaging findings were resolved. Posterior reversible encephalopathy syndrome should be considered in the differential diagnosis of patients with APSGN developing sudden neurological symptoms without severe increases in BP.