IconPost Streptococcal Acute Glomerular Nephritis  (PSAGN)

Post streptococcal AGN (PSAGN)

  • The most commonly recognized clinical picture (i.e., PSAGN) follows infection with group A beta hemolytic streptococci.
  • More common in children between the ages of 5 and 12 M > F.
  • Symptoms of AGN usually occur around 2- 3 weeks after a streptococcal throat infection or 4- 6 wks after skin infection
  • Frequency of clinical Manifestations in ASPGN:

  • Edema 85%
  • Hypertension 60-80%
  • Gross hematuria 30-50%
  • Circulatory Congestion 20%
  • CNS symptoms 10%
  • Investigations

  • Urinalysis
  • CBC, ESR
  • S.Creatinine
  • S.Proteins / S. Albumin
  • S.Electrolytes & HCO3
  • C3 ASO titer, AntiDNase B OR Streptozyme test can be done for E/O preceding strepto infection
  • AGN

  • >5 years
  • Cola colored urine with edema
  • Hypertension very common
  • Supportive therapy
  • Unusual to occur again
  • Can involve other family members & epidemics can occur
  • Treatment for APSGN

  • Salt & Fluid restriction
  • Daily Weight & strict Inout/Output chart
  • Hypertension- Diuretics, Ca. Channel Blockers or Vasodilators
  • Correction of Acidosis
  • Antistreptococcal antibiotics for house hold contacts
  •  

    Typical PSAGN

  • No C/F of Systemic disease.
  • C3 low during acute phase & returns to normal by 6-8 wks
  • Recovery begins in one week- Diuresis BP normalizes S.Creat falls
  • Gross hematuria resolves by 2-3 wks
  • Proteinuria resolves by 3-6 months
  • Microscopic hematuria resolves by 1 year
  • Hyperkalemia in AGN:

  • Pathogenesis: Decreased GFR, Acidemia
  • Therapeutic Strategies:Increased excretion Limit intake
  • Specific Measures: Decrease intake
  • S.K-5-6 mEq/L Diet + Frusemide
  • S.K 6-6.5- Add Sodabicarb, K exchange resin
  • S.K >6.5- G I drip, consider dialysis
  • Indications For Dialysis

  • Fluid Over load- Pulmonary oedema
  • Hyperkalemia
  • Acidosis
  • Worsening renal Function/ Azotemia
  • NS

  • 2-6 Yrs
  • Only oedema
  • Hypertension uncommon
  • Steroids form mainstay of treatment
  • Relapses common
  • Uncommon in other family members

  • Clinic : 102, Temple Avenue, 3rd Floor, Deodhar Road, Matunga (CR), Mumbai 400019

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    email: drmehtaks@kidskidneycare.in | drmehtaks@yahoo.co.in

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