This is a disease characterised by intraglomerular inflammation and cellular proliferation following bacterial infection and deposition of immune complexes in autoimmune diseases.

COMMON CAUSES

A. Infections

• Post streptococcal infections
• pharyngeal infection

• skin sepsis (impetigo)
• infected scabies
• Other bacterial Infections e.g.. Salmonella, Brucella

• Hepatitis B virus, Hepatitis C virus, Yellow Fever, HIV, Dengue, Hanta viruses
• Parasitic e.g. Toxoplasma, Trypanosoma, Schistosoma, Malaria

B. Systemic Lupus Erythematosus

C. Systemic Vasculitis

• Polyarteritis nodosa
• Wegener’s granuloma

SYMPTOMS

Common symptoms in children are:

• A history of preceding infection
• Generalized oedema most marked around the eyes
• Breathlessness
• Anorexia: sometimes associated with vomiting and abdominal pain
• Fever
• Seizures
• Urinary abnormalities: oliguria, haematuria

SIGNS

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Patients often present with:

• Oedema
• Oliguria (urine volumes <400 ml/day)
• Hypertension
• Haematuria, dark coloured urine.
• Acute Heart Failure
• Coma

INVESTIGATIONS

• Urinalysis

• Sediment shows erythrocytes, leukocytes and a variety of casts including erythrocyte casts
• Proteinuria usually less than 2 g/24 hours but may be in the nephrotic range

• Full Blood Count
• BUE and Creatinine
• Throat cultures (in children may be useful)
• Chest X-ray (may show pulmonary oedema)
• ECG
• Immunology

• ASO (antistreptolysin O) titres

TREATMENT

(Evidence rating: C)

Post Infectious Glomerulonephritis

• Diuretics - Furosemide (Frusemide) 40 mg daily, increasing to 2 g daily in adults
• Treat complications when detected i.e. renal failure, cardiac failure and hypertensive crisis.

REFER

• This may be done when complications such as renal failure, severe cardiac failure and hypertensive encephalopathy arise following Post Infectious Glomerulonephritis

• Patients with other causes such as lupus nephritis or systemic vasculitis, who need more intensive investigations, including renal biopsy, should be referred.