Symptoms of acute poststreptococcal glomerulonephritis

Symptoms of acute poststreptococcal glomerulonephritis caused by group A hemolytic streptococcus are well known. The development of jade is preceded by a latent period, which after pharyngitis is 1-2 weeks, and after skin infection is usually 3-6 weeks. During the latent period, in some patients, the microhematuria that precedes the unfolded clinical picture of nephritis is revealed.

In some patients, the symptoms of acute poststreptococcal glomerulonephritis consist in the presence of only microhematuria, in others - develop macrogematuria, proteinuria, sometimes reaching the nephrotic level (> 3.5 g / day / 1.73 m ² ), arterial hypertension and edema. In rare cases, the clinical course becomes "rapidly progressive", with rapidly growing uremia, which is usually combined with the development of widespread extracapillary proliferation in the glomeruli and the formation of a large number of "semilunium" (extracapillary nephritis). However, the symptoms of acute post-streptococcal glomerulonephritis are almost absent. In epidemics, the number of patients with subclinical form is 1.5 times higher than the number of patients with a developed clinical picture. When observing children who have suffered streptococcal infection of the upper respiratory tract, it was found that for every case of nephritis with clinical manifestations, 19 subclinical cases occur. In prospective studies in families, the ratio of subclinical to clinical cases was 4.0 to 5.3.

For the first time, acute oesophrenic syndrome as a manifestation of an acute period of scarlet fever was described during the epidemic in the 18th century. Acute nasopharyngeal syndrome remains the most typical manifestation of acute diffuse proliferative post-streptococcal glomerulonephritis and is commonly called acute glomerulonephritis. In 40% of patients there is a detailed clinic of acute cold syndrome - edema, hematuria, hypertension, oliguria, and in 96% of patients - at least two of these symptoms. A typical picture of a patient with acute diffuse proliferative poststreptococcal glomerulonephritis is a boy from 2 to 14 years old, whose eyelids and faces suddenly develop, the urine becomes dark with a decrease in its quantity, blood pressure rises. Typically, the volume of urine after 4-7 days increases with the subsequent rapid disappearance of edema and normalization of blood pressure.

• Hematuria is an indispensable symptom, which can be the only manifestation of jade; Only in exceptional cases, the diagnosis of acute glomerulonephritis can be made with normal urine sediment. In 2/3 of the patients, a microhematuria is found, in others, the urine has a dark brown color. Macrogematuria after an increase in diuresis usually disappears, but the microhematuria can persist for many months after an acute period.
• Edema is the main complaint of most patients. In adolescents edema is usually limited to localization on the face and ankles, while in younger children they are more generalized. The cause of swelling in acute glomerulonephritis is a decrease in glomerular filtration - a functional manifestation of damage to the renal glomeruli: an inflammatory reaction in the glomeruli leads to a decrease in CF, reducing the filtration surface of the capillaries and causing shunting of blood between the capillaries. In this case, the renal blood flow is normal or even elevated. Another cause of edema is a pronounced sodium retention, which is also observed in patients with moderately reduced CF, while diuresis can spontaneously increase even before the recovery of CF.
• Hypertension develops in more than 80% of patients, but only half of them require the appointment of antihypertensive drugs; rarely the course of acute glomerulonephritis is complicated by the development of hypertensive encephalopathy. When developing symptoms of CNS involvement - drowsiness or seizures - it is necessary to keep in mind the possibility of systemic lupus erythematosus or haemolytic-uremic syndrome. The cause of hypertension in acute glomerulonephritis is an increase in the volume of circulating blood associated with fluid retention, combined with an increase in cardiac output and peripheral vascular resistance. The course of acute syndrome can be complicated by the development of congestive heart failure as a result of fluid retention and severe hypertension.
• Proteinuria is a very important sign of glomerular disease, the result of damage to the capillary wall of the glomerulus. Proteinuria of 3 g / day or more, isolated or combined with other signs of nephrotic syndrome, is observed only in 4% of children with acute poststreptococcal glomerulonephritis, in contrast to the high frequency of "massive" proteinuria in adults with this, as well as other diseases with the morphology of the endocapillary proliferative glomerulonephritis (systemic lupus erythematosus, shunt-nephritis, nephritis in visceral abscesses).

Nonspecific symptoms of acute poststreptococcal glomerulonephritis - general malaise, weakness, nausea, sometimes with vomiting, often supplement the clinical signs of acute glomerulonephritis.

About 5-10% of patients feel dull pain in the lower back, which is explained by the expansion of the capsule of the kidneys as a result of edema of the parenchyma. The course of acute glomerulonephritis in children and adults (especially the elderly) of patients is significantly different. In adults, dyspnea, congestion in the lungs, oliguria, massive proteinuria, azotemia and death in the acute period of the disease are much more common. A poor prognosis may be associated with concomitant diabetes, cardiovascular and hepatic diseases, or with the severity of kidney disease itself.

Symptoms of acute diffuse proliferative post-streptococcal glomerulonephritis

Symptoms	Frequency,%
Edema	85
Macrogematuria	Thirty
Back pain	5
Oliguria (transient)	50
Hypertension	60-80
Nephrotic syndrome	5

[1], [2], [3], [4], [5]