Kidney nontumor / medical renal
Glomerular disease
Infectious glomerulonephritis
Acute postinfectious glomerulonephritis
Author: Nikhil Sangle, M.D.
Last author update: 3 March 2014
Last staff update: 2 May 2023 (update in progress)
Copyright: 2002-2023, PathologyOutlines.com, Inc.
PubMed Search: Post-infectious glomerulonephritis
Table of Contents
Definition / general | Pathophysiology | Diagrams / tables | Clinical features | Case reports | Microscopic (histologic) description | Microscopic (histologic) images | Immunofluorescence description | Immunofluorescence images | Electron microscopy descriptionCite this page: Sangle N. Acute postinfectious glomerulonephritis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/kidneypoststrep.html. Accessed June 2nd, 2023.
Definition / general
- Also called post streptococcal or acute glomerulonephritis; a type of diffuse endocapillary proliferative glomerulonephritis
Pathophysiology
- Deposition of immune complexes from antibodies against organisms elicits acute inflammatory response and nephritic syndrome
- Associated with nephritogenic strains of Streptococcus pyogenes (beta hemolytic Strep group A)
- Similar histologic findings also associated with endemic malaria, toxoplasmosis, hepatitis B/C, HIV, varicella, spirochetes, staphylococci (Clin J Am Soc Nephrol 2006;1:1179), meningococci and other bacteria
- Similar process occurs in response to endogenous antigen in SLE
Diagrams / tables
Images hosted on other servers:
Diagram
Clinical features
- Post-streptococcal disease is decreasing in US (eMedicine - Poststreptococcal Glomerulonephritis)
- 95% recover with conservative therapy; 1% develop rapidly progressive glomerulonephritis, 1 - 2% develop chronic glomerulonephritis
- Poor prognosis more likely if massive proteinuria and abnormal GFR; 2 - 5% die from pulmonary edema, hypertensive encephalopathy or crescentic glomerulonephritis; children with obesity may have greater renal injuries (Clin Nephrol 2009;71:632)
- Children age 6 - 10: nephritic presentation with abrupt onset of hematuria, oliguria, fever, malaise and nausea 1 - 4 weeks after strep infection of pharynx or skin (impetigo); RBC casts, proteinuria, periorbital edema and hypertension
- Adults: may have atypical presentation with sudden hypertension, edema and elevated BUN; 60% recover, others develop rapidly progressive glomerulonephritis (Arab J Nephrol Transplant 2012;5:93, J Med Assoc Thai 2006;89 Suppl 2:S157)
- Laboratory (children and adults): high antistreptococcal antibody titers, low C3 (due to consumption)
Subclinical:
- Typical immune complex deposition of clinical disease, but with minimal symptoms or urinary abnormalities
- Important to recognize, since present in 10% of renal biopsies (Hum Pathol 2003;34:3)
Case reports
- 4 year old boy with adenovirus infection (Isr Med Assoc J 2009;11:758)
- 6 year old girl and 12 year old boy with simultaneous occurrence with hemolytic uraemic syndrome (Eur J Pediatr 2001;160:173)
- 11 year old boy with sinus related orbital abscess (Arq Bras Oftalmol 2008;71:579)
- 42 year old male kidney transplant recipient with Salmonella infection (Clin Nephrol 2007;67:321)
Microscopic (histologic) description
- Glomeruli are globally and diffusely enlarged and hypercellular due to neutrophils and macrophages and proliferation of mesangial and endothelial cells (also called ‘exudative’ glomerulonephritis)
- Swelling of endothelial cells and presence of inflammatory cells obstructs capillary lumina
- Returns to normal within months
- Slight mononuclear leucocytic infiltrate and edema in the interstitium
- Tubules contain red blood cells
Microscopic (histologic) images
Images hosted on other servers:
Markedly hypercellular glomeruli due to neutrophils
Various images
Immunofluorescence description
- Lumpy bumpy (granular) deposition of IgG, IgM and C3 in peripheral glomerular loops
- Also properdin; no C1q or C4
Immunofluorescence images
Images hosted on other servers:
Lumpy bumpy (granular) or starry scar immunofluoresence
Electron microscopy description
- Subepithelial ‘humps’ (finely granular, dome-shaped, electron dense, representing immune complex deposits), no spikes (compare to membranous glomerulonephritis)
- Obliteration of epithelial cell foot processes
- Subepithelial, intramembranous, subendothelial and mesangial deposits in the acute phase
