Glomerulonefritis aguda post-infecciosa: Evaluación y manejo.

Abstract

Acute post-infectious glomerulonephritis (APIGN) is an immune-mediated syndrome, caused by a glomerular injury in response to an extra-renal infection, a pharyngeal or skin infection caused by Group A beta-hemolytic Streptococci precedes the glomeruli affection in 95% of cases. Incidence is typically much greater in underdeveloped countries, and the target population varies between children of 5 and 12 years old. Clinical manifestations vary, but the most common findings are hematuria, edema, and hypertension; also known as the nephritic triad.

APIGN has a multifactorial pathogenesis, in situ immune complex formations in the subepithelial glomerular space causing type III hyper sensibility reaction, it´s the most relevant mechanism. 

The diagnosis is made by clinical judgment, the use of Anti-DNA-B, ASO, and C3 levels; are helpful in identifying Streptococci infection to support the diagnosis.   Due to its auto limited nature, treatment is mainly based on supportive measures. The use of diuretics, fluid and sodium restriction, represent the main strategy applied in our country; the use of antihypertensives is needed in some cases. APIGN has excellent long-term outcomes, recurrence is very rare, and complication rates are minimal. In case of persistent affections after a prudent period of time, consultation with a pediatric nephrologist is warranted.