Poststreptococcal Glomerulonephritis Diagnosis and Management

Clinical Presentation and Diagnostic Considerations

• Proteinuria is usually moderate (1-3 g/day) in patients with poststreptococcal glomerulonephritis (PSGN) 1
• Urinalysis showing dysmorphic red blood cells and red cell casts is characteristic of glomerular disease, including PSGN 1
• The American Academy of Family Physicians suggests that the presence of dysmorphic red blood cells and red cell casts strongly suggests glomerular disease 4
• Tea-colored urine with proteinuria (>2+ by dipstick) further supports glomerular origin, according to the American College of Radiology 5

Differential Diagnosis and Diagnostic Algorithm

• Poststreptococcal glomerulonephritis (PSGN) should be included in the differential diagnosis for a patient presenting with microscopic hematuria, subnephrotic proteinuria, and hypertension, as recommended by the American Journal of Kidney Diseases 2
• IgA nephropathy (Berger disease) is a potential differential diagnosis for patients with microscopic hematuria, subnephrotic proteinuria, and hypertension, according to the Journal of the American College of Radiology 3
• ANCA-associated vasculitis is another potential differential diagnosis for these patients, as suggested by Kidney International 1
• Renal ultrasound may show enlarged kidneys with increased cortical echogenicity in acute glomerulonephritis, as noted by the Journal of the American College of Radiology 3

Management Approach

• Appropriate antibiotic treatment (penicillin or erythromycin if penicillin-allergic) is recommended for patients with PSGN, even in the absence of persistent infection, according to the American Journal of Kidney Diseases 2
• The American Journal of Kidney Diseases recommends screening for ANCA antibodies to rule out vasculitis in patients with suspected PSGN 1