Review Question - QID 100965

Age is the most important prognostic factor in post-streptococcal glomerulonephritis. Ninety-five percent of affected children recover completely, compared with 25% of adults over 60 years old.

Though it may be asymptomatic, presentation of acute post-streptococcal glomerulonephritis includes hematuria, periorbital edema, respiratory distress, and hypertension occurring 1-4 weeks post-impetigo or strep pharyngitis. Urinalysis shows proteinuria and hematuria as well as red blood cell casts. Treatment includes penicillin to lessen remaining infectious burden, diuresis, and antihypertensives as necessary. Sequelae include progressive renal damage leading to chronic kidney disease, particularly in adults.

Hahn et al. review common presentations of post-streptococcal illness. In addition to glomerulonephritis, acute rheumatic fever is a serious complication of streptococcal infection. Its symptoms include arthritis, carditis, cutaneous disease, chorea, and valvular disease.

Nasr et al. describe common scenarios for infection in the elderly based on a cohort of 109 cases among patients older than 65 years of age. Those who had underlying diabetic glomerulosclerosis, higher serum creatinine, and more interstitial fibrosis were more likely to progress to end-stage renal disease.

Illustration A shows the pathologic mechanism, classic pathology, and EM images from an affected kidney; note the "lumpy bumpy" appearance.
Illustration B shows red blood cell casts of glomerulonephritis.

Incorrect Answers:
Answers 1, 2, & 4: Older adults are more likely to progress to end-stage renal disease.
Answer 5: Corticosteroids may be used in refractory cases but are unlikely to result in a cure.