An 18 y.o. student is admitted with dark urine, fever, and flank pain and is diagnosed with acute glomerulonephritis. Which would most likely be in this student’s health history?
A. Renal calculi
B. Renal trauma
C. Recent sore throat
D. Family history of acute glomerulonephritis
Correct Answer: C. Recent sore throat
The most common form of acute glomerulonephritis is caused by group A beta-hemolytic streptococcal infection elsewhere in the body. Poststreptococcal glomerulonephritis (PSGN) results from a bacterial infection that causes rapid deterioration of the kidney function due to an inflammatory response following streptococcal infection. PSGN most commonly presents in children 1 to 2 weeks after a streptococcal throat infection, or within 6 weeks following a streptococcal skin infection.
Option A: Nephrogenic streptococci infection precedes PSGN, which initially affects skin or oropharynx. More recently, PSGN is associated with skin infections (impetigo) more frequently than throat infections (pharyngitis). Group A Streptococcus (GAS) has been subtyped depending on the surface M protein and opacity factor, which are known to be nephrogenic and can cause PSGN.
Option B: Other causes of post-infectious glomerulonephritis include bacterial (endocarditis, enterocolitis, pneumonia, intraventricular shunt infections), viral (hepatitis B and C infections, human immunodeficiency virus, cytomegalovirus, Epstein Barr virus, parvovirus B19), fungal (coccidioidomycosis, histoplasmosis), and parasitic infections (malaria, leishmania, toxoplasmosis, and schistosomiasis).
Option D: Genetic factors are expected to predispose to the condition since almost 40% of patients with PSGN gave a positive family history. There is no specific gene found to cause PSGN. Poor hygiene, overcrowding, and low socioeconomic status are important risk factors for streptococci outbreaks, and this explains the higher incidence of PSGN in impoverished countries.
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