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PSGN

Post-streptococcal glomerulonephritis (PSGN) is an immune complex-mediated condition that follows infections with nephritogenic strains of Group A beta-hemolytic Streptococcus, commonly after pharyngitis or impetigo. It is characterized by nephritic syndrome symptoms, including hematuria, edema, and hypertension, primarily affecting children aged 5-15. Diagnosis is based on clinical presentation, laboratory findings, and recent streptococcal infection history, with kidney biopsy rarely needed.

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PSGN

Post-streptococcal glomerulonephritis (PSGN) is an immune complex-mediated condition that follows infections with nephritogenic strains of Group A beta-hemolytic Streptococcus, commonly after pharyngitis or impetigo. It is characterized by nephritic syndrome symptoms, including hematuria, edema, and hypertension, primarily affecting children aged 5-15. Diagnosis is based on clinical presentation, laboratory findings, and recent streptococcal infection history, with kidney biopsy rarely needed.

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Renal pathology ​

Post Streptococcal
Glomerulonephritis
Definition

Post-streptococcal glomerulonephritis (PSGN) is a classic example of immune complex-mediated


glomerulonephritis that typically follows infection with certain nephritogenic strains of Group A
beta-hemolytic Streptococcus (GAS), particularly Streptococcus pyogenes.

Etiology

●​ Most commonly follows:​

○​ Pharyngitis (1–3 weeks after infection)​

○​ Impetigo (skin infection; 3–6 weeks later)​

●​ Caused by nephritogenic strains of GAS with M protein types 1, 4, 12 (pharyngitis) and 49,
55, 57, 60 (impetigo).​

Pathogenesis

●​ Immune complexes (streptococcal antigens + antibodies) deposit in glomeruli.​

●​ Activation of complement (especially C3) → inflammation and damage to glomerular


basement membrane.​

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Histopathology

●​ Light microscopy: Enlarged, hypercellular glomeruli due to neutrophils and monocytes.​

●​ Immunofluorescence: “Starry sky” or granular appearance due to deposition of IgG, IgM,


and C3.​

●​ Electron microscopy: Subepithelial humps (immune complex deposits).​

Clinical Features

●​ Most common in children (ages 5–15).​

●​ Features of nephritic syndrome:​

○​ Hematuria (”cola-colored urine”)​

○​ Periorbital edema​

○​ Hypertension​

○​ Oliguria​

○​ Proteinuria (mild to moderate)​

○​ Fever, malaise, sore throat may precede renal symptoms.​

Laboratory Findings

●​ Urinalysis: RBCs, RBC casts, mild proteinuria.​

●​ ↓ Serum C3 (returns to normal in 6–8 weeks).​

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●​ ↑ Anti-streptolysin O (ASO) titers (more with pharyngitis).​

●​ Anti-DNase B (better marker in impetigo).​

●​ Elevated serum creatinine and BUN if significant renal involvement.​

Diagnosis

●​ Based on clinical presentation, lab findings, and recent history of streptococcal infection.​

●​ Throat or skin culture may help if active infection is still present.​

●​ Kidney biopsy rarely needed unless atypical presentation.​

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