Abstract Body

Backgrounds and purpose

Poststreptococcal glomerulonephritis is prototypical for postinfectious glomerulonephritis (PIGN) and represents the most common cause of nephritic syndrome in childhood and young adults. The overall incidence has decreased, but PIGN is a significant problem in disadvantaged populations, where it is epidemic. In developed countries, it is typical in the elderly with comorbidities.

This entity is an immune-mediated glomerular inflammation triggered 1-6 weeks after throat or skin infection. Clinical presentation varies from an asymptomatic condition to rapidly progressive glomerulonephritis. Biopsy confirms the diagnosis but is rarely necessary. Clinical features and hypocomplementemia are essentially confirmatory. Treatment is supportive and prognosis is usually excellent, although long-term follow-up may be needed.

Case presentation

A 20-year-old woman, with no relevant medical history, was referred to the Emergency Department presenting hematuria, oliguria and generalized swelling for two days. She described a fully recovered pharyngotonsillitis treated with antibiotic 15 days ago.

Physical examination showed BP 168/92mmHg and eyelid and bilateral lower-leg edema. Laboratory test: SCr 7.12mg/dl, GFR 8ml/min, hypocomplementemia-C3, increased ASO titers and negative serologies. Urinalysis: hematuria and mild proteinuria.

Supportive treatment, including loop diuretics and restrictions of fluids and sodium, was initiated with good response. Based on clinical and laboratory findings, PIGN diagnosis was established. Biopsy was not necessary.

Conclusion

The previous case fits perfectly as the typical presentation of PIGN. Signs of acute kidney injury such as oliguria, edema and hypertension after an infection should be identified early in Primary Healthcare to refer these patients to the Emergency Department for further tests and treatment if necessary.