Postinfectious glomerulonephritis represents an inflammatory process in the kidney corpuscles (medical term glomeruli). The cause of the disease is an immune system reaction to a specific type of pathogen called nephritogenic streptococci. In the majority of cases, postinfectious glomerulonephritis occurs between the ages of two and ten in affected patients. In addition, observations indicate that males develop postinfectious glomerulonephritis more often than females.
What is postinfectious glomerulonephritis?
Postinfectious glomerulonephritis is sometimes called poststreptococcal glomerulonephritis. Basically, the disease involves acute inflammation of the renal corpuscles. Usually, postinfectious glomerulonephritis develops a few weeks following an infection of the organism with a specific form of streptococcus. Often the disease develops in the first to fourth week after such an infection. It can be observed that postinfectious glomerulonephritis is increasingly triggered by other types of pathogens. These include, for example, various viral and bacterial pathogens, as well as parasites and fungi. The immune complexes accumulate within the capillaries of the renal corpuscles, causing damage to the organ. This is because the accumulation of the substances stimulates the so-called complement system. As a result, various complaints appear in those suffering from post-infectious glomerulonephritis. In many cases, dark-colored urine as well as hematuria are among the characteristic complaints.
Causes
Infections with so-called category A nephritogenic streptococci are usually the most common cause of postinfectious glomerulonephritis. Infection with the pathogens is possible either via the respiratory tract or the skin. As a result of the infection, the affected organism produces special antibodies. On the one hand, these are specialized on the epitopes on the surface of the streptococci, but at the same time also on the body’s own renal corpuscles and their structural composition. The antibodies produced by the immune system accumulate on the surface of the basal membranes of the renal corpuscles. This results in bulges, which are clearly visible in electron microscope examinations. As a result, the organism reacts with inflammation, which is characterized by various features. Certain types of granulocytes cause a release of so-called proinflammatory cytokines. In addition, the complement system is stimulated, resulting in the formation of special lysis complexes. Finally, the basal membrane of the glomeruli is damaged. Due to the inflammatory processes, the endothelial cells swell. In addition, the capillaries close. In modern times, post-infectious glomerulonephritis is not only caused by streptococci, but in some cases also by gram-negative germs, fungi or viral germs. Even infestation of the organism with certain parasites sometimes triggers postinfectious glomerulonephritis.
Symptoms, complaints, and signs
Postinfectious glomerulonephritis is manifested by a specific symptomatology that suggests the disease during medical examination. Usually, the typical symptoms develop circa one to three weeks after the causative infection with the pathogens. Persons suffering from post-infectious glomerulonephritis suffer, for example, from general symptoms such as pain in the area of the head, fever as well as abdominal pain. In addition, there is a brownish or dark colored urine. Proteinuria also develops, resulting in the formation of so-called periorbital edema. In addition, many patients suffer from hypertension. The dark urine results in particular from the fact that increased erythrocytes are excreted from the organism via the urine. This phenomenon is also known as hematuria. The function of the kidneys decreases in most cases, while at the same time the formation of urine decreases. In addition, it has been shown that treatment with drugs has little effect on the disease. In the majority of cases, postinfectious glomerulonephritis is self-limiting, so that the prognosis is comparatively positive.However, various complications are possible, such as cerebral edema, renal impairment, and epileptic seizures.
Diagnosis and course of the disease
The physician makes the diagnosis of postinfectious glomerulonephritis primarily on the basis of the characteristic clinical symptoms of the disease. To this end, he or she takes a medical history with the patient to gain insight into the individual’s symptoms. After talking to the affected person, the physician examines the symptoms using various procedures. An important role is played here by analyses of the urine, which can be used to detect erythrocyte and proteinuria. A so-called leukocyte cylinder can also be detected. In addition, typical phenomena such as hyponatremia and hyperkalemia are seen in the case of kidney weakness. As a rule, elevated concentrations of urea and creatinine do not occur. Such investigations usually allow a relatively reliable diagnosis of postinfectious glomerulonephritis.
Complications
Postinfectious glomerulonephritis is already a complication of infectious disease. However, the prognosis is very good in the vast majority of cases. However, this also depends on whether children or the elderly are affected. In children, the symptoms usually disappear quickly after an acute course. However, serious complications can develop in one to ten percent of children with the disease. For unknown reasons, the disease then develops in a flash, which can lead to kidney failure, cerebral edema and seizures. In the course of renal insufficiency, the patient often requires regular dialysis or even a kidney transplant. Furthermore, the occurrence of cerebral edema is a very serious complication. In addition to severe headaches, nausea, vomiting and dizziness, breathing difficulties, visual disturbances, impaired consciousness and even coma, as well as unusual hiccups are observed. The violent increase in pressure in the brain often results in displacement and compression of vital brain structures. This leads to life-threatening situations. In the elderly, the prognosis of postinfectious glomerulonephritis is often much worse than in children. This is especially true for those affected who suffer from diabetes, malnutrition or alcoholism. Approximately 20 to 25 percent of all elderly patients who have undergone postinfectious glomerulonephritis die of heart failure, uremia, or renal failure.
When should you see a doctor?
Symptoms such as skin infections or water retention indicate postinfectious glomerulonephritis. A visit to the doctor is indicated if the signs of illness occur in association with a viral or bacterial infection. Then the sufferers must consult a specialist who can clarify the symptoms and prescribe an appropriate medication. The symptoms usually appear one week to one month after streptococcal infection. In some cases, postinfectious glomerulonephritis resolves on its own. If symptoms are mild and subside after four to seven days, a visit to the doctor is not necessarily required. Children, sick and elderly people as well as pregnant women should in any case go to the doctor with the disease. In addition to the family doctor, the internist is the right contact person. If the skin is involved, a dermatologist can be consulted. If neurological symptoms appear, the help of a neurologist is needed. If the symptoms are severe, a nephrologist, urologist or cardiologist may also be consulted to treat the individual symptoms.
Treatment and therapy
Treatment of postinfectious glomerulonephritis is tailored to the individual case. When renal function is impaired, regulation of water and salt balance is necessary. Diuretic agents and antihypertensives are usually used for this purpose. This reduces the risk of high blood pressure and edema. In addition, patients often receive penicillins as a preventive measure.
Prevention
Preventive measures address the causes of postinfectious glomerulonephritis. The risk of infection can be reduced by hygienic standards.
Follow-up
For postinfectious glomerulonephritis, follow-up is largely outpatient and only supportive of recovery.In most cases, the disease subsides after several days even without medical treatment. However, the body should be supported by measures such as bed rest, restricted fluid intake and adherence to a low-sodium and low-protein diet until complete healing. Physical exertion should be avoided. After the disease with post-infectious glomerulonephritis, a follow-up visit to the family doctor is advisable to clarify whether the kidney function has returned to normal. Especially in patients with additional complications such as edema or electrolyte disturbances, this is very important to avoid complications. Furthermore, in severe cases, the doctor may prescribe additional antibiotic treatment to prevent the spread of streptococci to other people. Here it is important to pay attention to the correct intake. The prognosis in postinfectious glomerulonephritis is generally positive. Young patients usually recover full renal function. In adults, however, the tendency is worse, so that permanent kidney damage can occur, especially in combination with other risk factors. This should be controlled and monitored in the long term.
What you can do yourself
Since postinfectious glomerulonephritis generally responds very well to medical treatment, major restrictions on everyday life are not usually to be expected. Children in particular should be offered distraction during prolonged hospital stays. Regular visits by family and friends are just as much a part of this as meaningful occupation. For example, friends and companions can be brought along to the next visit. Helping with any homework, etc., also takes your mind off things and helps prevent missing too much study material. Taking diuretic medications means that younger children’s diapers need to be changed much more frequently and the wet intimate area needs to be kept dry. If the child prefers to go to the toilet, assistance should of course be offered where necessary. Great importance should be attached to good intimate hygiene. It is also the task of the parents to comfort the little ones and to support them during any examinations that may be necessary. Just holding their hand can be sufficient and effectively reduce stress.
