Poststreptococcal glomerulonephritis (PSGN) is the most common cause of nephritic syndrome in children. PSGN typically occurs 1-3 weeks after a group A beta hemolytic streptococcal (GAS) pharyngitis or 3-6 weeks after a GAS skin infection. It is thought to be a glomerular immune complex disease leading to complement activation and triggered by specific nephrogenic strains of GAS.
The clinical features of PSGN are varied, with a majority of children presenting with asymptomatic microscopic hematuria. Common clinical features in symptomatic children include peripheral edema, hypertension, gross hematuria with characteristic tea- or cola-colored urine, acute kidney injury, and proteinuria, which at times reaches nephrotic levels.
Children typically have a good prognosis with normalization of creatinine. Adults may have residual effects of hypertension, recurrent proteinuria, and persistence of abnormal renal function.
Acute poststreptococcal glomerulonephritis
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Synopsis
Codes
ICD10CM:
N00.9 – Acute nephritic syndrome with unspecified morphologic changes
SNOMEDCT:
68544003 – Acute post-streptococcal glomerulonephritis
N00.9 – Acute nephritic syndrome with unspecified morphologic changes
SNOMEDCT:
68544003 – Acute post-streptococcal glomerulonephritis
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Differential Diagnosis & Pitfalls
Clinical history is crucial to the diagnosis of PSGN. A recent history of a GAS infection in the setting of nephritic syndrome symptoms supports the PSGN diagnosis.
Alternative diagnoses to consider:
Alternative diagnoses to consider:
- Urinary tract infection – Can present with hematuria, but would be associated with dysuria, urgency, and increased frequency as well as leukocyte esterase and nitrites on urinalysis.
- Rapidly progressive glomerulonephritis (RPGN) – PSGN more likely to progress to RPGN in adults than children.
- Anti-glomerular basement membrane antibody disease (Goodpasture disease) – Will often present with hemoptysis.
- Granulomatosis with polyangiitis (formerly Wegener granulomatosis) – Presents with chronic sinusitis and cough, c-ANCA associated.
- Microscopic polyangiitis – Presents with purpura and cough, p-ANCA associated.
- Eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome) – Presents with asthma and sinusitis, p-ANCA associated.
- IgA nephropathy (Berger disease) / IgA vasculitis (formerly Henoch-Schönlein purpura) – Presents with palpable purpura and IgA nephropathy.
- Alport syndrome – Presents with hematuria, sensorineural hearing loss, vision problems, and family history.
- Membranoproliferative glomerulonephritis
- C3 nephropathy – Look for persistent depression of C3 levels.
- Hemolytic uremic syndrome – Often presents with diarrhea.
- Systemic lupus erythematosus nephritis
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Last Reviewed:01/06/2019
Last Updated:10/09/2022
Last Updated:10/09/2022