DESCRIPTION

• Glomerulonephritis presents with the nephritic syndrome: hematuria with red blood cell (RBC) casts, hypertension, variable azotemia, and edema. Proteinuria and oliguria may also be present.
• Acute glomerulonephritis is associated with inflammation and cell proliferation in the glomerular tuft. It may be rapidly progressive.
• Chronic glomerulonephritis indicates that permanent damage has occurred.

EPIDEMIOLOGY

• Postinfectious glomerulonephritis can occur after any infection; ~80% of cases are secondary to a streptococcal infection.
• Acute poststreptococcal glomerulonephritis (APSGN)
  • Can occur in anyone >2 years but is most frequently found in boys 5 to 15 years old
  • It can be sporadic or epidemic.
  • Incidence of APSGN has declined over the last 2 decades.
• Chronic glomerulonephritis occurs more often at the end of the 1st decade of life and in adults.

ETIOLOGY

Can be categorized based on serum complement levels and presence of renal-limited versus systemic disease

• Low serum complement level: systemic diseases
  • Vasculitis and autoimmune disease (e.g., systemic lupus erythematosus [SLE])
  • Subacute bacterial endocarditis (SBE)
  • Shunt nephritis
  • Cryoglobulinemia
• Low serum complement level: renal diseases
  • APSGN
  • Membranoproliferative glomerulonephritis (MPGN), C3 glomerulopathy
• Normal serum complement level: systemic diseases
  • Microscopic polyangiitis (MPA)
  • Granulomatosis with polyangiitis (GPA)
  • Henoch-Schönlein purpura (HSP)
  • Hypersensitivity vasculitis
  • Antiglomerular basement membrane (anti-GBM) disease (Goodpasture syndrome)
• Normal serum complement level: renal diseases
  • Immunoglobulin A (IgA) nephropathy
  • Idiopathic rapidly progressive glomerulonephritis
  • Pauci-immune glomerulonephritis (renal-limited antineutrophil cytoplasmic antibodies [ANCA] vasculitis)
  • Immune-complex disease

RISK FACTORS

Exposure to nephritogenic streptococci