The most common form of nephritis: acute post-infectious glomerulonephritis
Acute post-infectious glomerulonephritis (GNA) is the most common of the nephritis affecting children. It is most frequent after the third year of life
It typically begins 10-15 days after a non-specific infectious episode, often, but not exclusively, streptococcal in nature (pharyngitis, tonsillitis).
The initial symptom usually presents itself with dark coloured urine, varying in colour from so-called ‘flesh wash’ to ‘coke’ colour.
It may, however, also start simply with microscopic haematuria, not visible to the naked eye but only on urine examination.
Renal function is often normal, but cases with impaired renal function are possible, up to full-blown acute renal failure, with reduced urine output that, in rare cases, may necessitate temporary treatment with dialysis.
Especially in these cases, high blood pressure, poor diuresis and swelling of the face or legs (oedema) are often present.
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The diagnosis of acute postinfectious glomerulonephritis (GNA) requires:
- Urinary sediment examination which shows the presence of glomerular-type haematuria and erythrocyte or jalin-erythrocyte cylinders which consist of aggregates of red blood cells and proteins that form in the renal tubules.
- The most important test from a diagnostic point of view, however, is C3, which is reduced in more than 90% of cases. It is important that its normalisation is then demonstrated, which usually occurs within eight weeks; in cases where this does not occur, other diagnostic hypotheses must be formulated.
Other tests generally performed for the diagnosis of acute post-infectious glomerulonephritis (GNA:
- Plasma creatinine and potassium levels;
- Pharyngeal swab for the identification of group A beta-haemolytic streptococcus, the agent most frequently responsible for acute post-infectious glomerulonephritis. It should be pointed out that, once the immunological process leading to nephritis has set in, it becomes independent of the germ that triggered it and, therefore, its eradication does not affect the disease’s recovery time.
The prognosis of acute post-infectious glomerulonephritis is benign in more than 95% of cases:
- Typically, acute renal impairment resolves in about two months, although minor urinary sediment abnormalities (microhaematuria) may be seen up to 1-2 years after onset.
- The disease usually heals spontaneously and does not tend to recur, although a recurrence of macroscopic haematuria is possible in the immediate vicinity of the acute episode.
In rare cases, acute post-infectious glomerulonephritis may result in major renal injury leading to chronic renal failure or nephrotic syndrome.
The possible persistence of proteinuria, particularly after the end of macroscopic haematuria, is important as its presence may be a less favourable prognosis factor.
No treatment is required in uncomplicated forms, except for possible streptococcal clearance, which is now generally carried out with antibiotics administered orally.
In cases where renal insufficiency, hypertension or oedema are present, symptomatic supportive therapy may be necessary.
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