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Acute Glomerular Nephritis
Mao Jianhua, Department of Nephrology, The Children’s Hospital
of Zhejiang University School of Medicine
DEFINITION
EPIDEMIOLOGY
APSGN is a disease that affects primarily
children, with the peak incidence being between
ages of 2 and 6 years, Males are more likely
than females to have overt nephritis.
ETIOLOGY
Nephritogenic strains of β–
hemolytic streptococci
PATHOGENESIS
1. Immune complex glomerulonephritis caused by deposition of
circulating antigen-antibody complexes.
2. Autoimmune glomerulonephritis caused by deposited IgA being
directed against a mesangial antigen or neo-antigen.
3. Immune complexes are formed in situ in the mesangium in
response to a planted antigen.
PATHOLOGY
Endocapillary proliferative nephritis
Light microscopy
the glomeruli are found to be swollen
and filled with cells obscuring much of
the delicate network of the normal
glomerular tugt.
正常肾小球，用PAS染色以突出基底膜。肾小球血管袢薄而清晰。
Immunofluorescence microscopy
Glomerular deposits of IgG and C3 in
capillary and mesangium
Electron microscopy
1.The proliferation of cells is seen to involve
primarily endothelial cells and the
mesangium.
2.Electron-dense humps on the epithelial
side of the basement membrane.
Clinical Features
Classically:
1. Edema and oliguria
2. hematuria
3. hypertension
In some patients
1. Hypervolemia
2. Encephalopathy
3. Oilguric acute renal failure
LABORATORY FEATURE
■ Complement：C3, CH50
■ Blood
■ Renal function examination
■ ESR
■ urinalysis
■ ASO, ADNase-B, Ahase, et al.
Differential diagnosis

Rapidly progressive glomerulonephritis

Chronic glomerulonephritis

Infection-associated glomerulonephritis not caused by streptococcus

Secondary glomerulopathies
TREATMENT
Treatment of acute PSGN is
largely that of supportive care
1. Stay in Bed
2. DIET CONTROL
3. ANTIBIOTICS
4. Symptom control
diuretics and anti-hypertension therapy
1. Congested circulation
2. Encephlopathy
3. Acute renal failure
PROGNOSIS
Most children (up to 95%) fully recover from
APSGN in a matter of weeks or months. In those who
do not recover fully, chronic or progressive problems
of kidney function may occur. Kidney failure may
result in some patients.
Acute Post-Streptococcal GN
Synonyms: Acute proliferative glomerulonephritis,
acute post-infectious GN.
Incidence:
Peak incidence in children (3-14). Sporatic,
mostly winter and spring.
Etiology:
Glomerular trapping of circulating antistreptococcal immune complexes. Group A,
B-hemolytic streptococci, type 12.
Acute nephritic syndrome post-strept
pharyngitis or pyoderma. Other infections.
Clinical:
Lab:
Path:
Clinical
Course:
Nephritic urine with RBC casts. Evidence
of streptococcal infection or serologic
evidence of recent infection. Decreased
serum complement.
Enlarged, hypercellular glomeruli with
endothelial and mesangial cell
proliferation. Acute inflammation. IgG and
C3 in very coarsely granular pattern along
GBMs. Discrete, subepithelial “hump-like”
deposits.
Children - Excellent prognosis. Adults Worse prognosis, some develop
progressive disease.
Post-Streptococcal GN
CNS
Streptococcal
Infection
+ Strep Assay
Hypertension
Latent Period
Edema
Proteinuria
Acute Nephritis
Hematuria