Introduction

Most common form of

acute nefritic syndrome

Inflammation and proliferation of

glomerulus caused by imunological
process, with history of prior
streptococcal infection

APSGN

Management mainly supportive

Prognosis was excellent in most cases,

but remains an important causes of
AKI in developing countries

Iturbe BR, Mezzano S. Acute post infectious glomerulonephritis . Pediatric Nephrology. 2008
Eison M. T, Ault H.B. Post-streptococcal acute glomerulonephritis in children : clinical feature and pathogenesis.
Pediatr Nephrol. 2011
Rauf S, Albar H, Aras J. Konsensus glomerulonefritis akut pasca streptokokus.IDAI. 2012

ETIOLOGY
Streptokokus hemolitikus grup A
(SBHGA) nefritogenic
strain
Serotipe associated
with URI : M types
1,3,4,12,49

Serotipe associated
with pyodermitis :
M types 2,49,55,57,60

.
Pardede SO. Struktur sel streptokokus dan patogenesis glomerulonefritis akut pascastreptokokus. Sari Pediatri. 2009. h 56-65.
Rodriguez B, Musser J. J Am Soc Nephrol 2008.

CLINICAL
MANIFESTATION
Hematuria

Decreased
GFR

Edema

ANS
Proteinuria

Hypertension

Eison M. T, Ault H.B. Post-streptococcal acute glomerulonephritis in children : clinical feature and
pathogenesis. Pediatr Nephrol. 2011;26:165-80.

Urine

Gross Hematuria in Children

APSGN

Henoch Schonlein Purpura

Abdominal pain, joint pains, rash, arthralgia
IgA Nephropathy
Recurrent, painless gross hematuria
SLE
Fever, weight loss, fatigue, arthritis
Alport Syndrom

Family history of renal disease that led to ESRD

Welch TR. An approach to the child with acute glomerulonephritis, review article. Int J Pediatr. 2012;3:1-3.

CLINICAL MANIFESTATION
3 Phases

Latent
phase
1-2 weeks in upper respiratory infection
3-6 weeks in skin infection (pioderma)

Acute
phase
6-8 weeks

Recovery
phase
After resolution of overload,
along with n BP, resolution of
proteinuria, and gross
hematuria

Eison M. T, Ault H.B. Post-streptococcal acute glomerulonephritis in children : clinical feature and pathogenesis. Pediatr Nephrol.
2011;26:165-80.

CLINICAL MANIFESTATION

Eison M. T, Ault H.B. Post-streptococcal acute glomerulonephritis in children : clinical feature and pathogenesis. Pediatr Nephrol.
2011;26:165-80.

DIAGNOSIS
History
Clinical
manifestations

Urinalysis
Laboratorium
Biopsy

History of antecendent upper respiratory tract or skin infection

Acute nephritic syndrome

RBCs, frequently in asscociation with RBC casts, proteinuria,

leukosituria

ASO , antihialurodinase
C3 and normal C4
Pharyngeal swab culture

Usually not indicated

Behrman RE, Kliegman R. Acute postreptococal glomerulonephritis. Dalam : Nelsons Essentials of Pediatrics. Philadelpia : WB
Saunders and company; 2004. hal 1740-1.

MANAGEMENT
Goals

Supportive

Treat the acute effect of renal insufficiency and

hypertension
Salt restiction
Antihypertension
Antibiotic
and loop diuretic

Behrman RE, Kliegman R. Acute postreptococal glomerulonephritis. Dalam : Nelsons Essentials of Pediatrics.
Philadelpia : WB Saunders and company; 2004. hal 1740-1.

COMPLICATIONS
hypertensive encephalopathy
acute lung edema
acute renal failure

Albar H, Rauf S. The profile of acute glomerulonephritis among Indonesian Children. Paediatr
Indones. 2005;45:2649.

Management of hypertensive crisis

Nifedipine
0.1-0.5 mg/kg sublingual, with a maximum total
dose of 10 mg
Can be repeated every30 minutes
Onset within 1-5 minutes
Side effect: precipitous fall of BP
The Fourth Report on the Diagnosis, Evaluation,
and Treatment of High Blood Pressure in Children
and Adolescents, Pediatrics 2004

Management of hypertensive crisis

Clonidine
0.002 mg/kg/dose IV slow 4 times a day
Can be increased up to 0.006 mg/kg/dose
Onset: 5 minutes

Duration: few hours

Side effect: rebound hypertension
5-10 mcg/kg/day oral
The Fourth Report on the Diagnosis, Evaluation,
and Treatment of High Blood Pressure in Children
and Adolescents, Pediatrics 2004

Management of hypertensive crisis

Nicardipine
1-5 mcg/kg/min as a continuous infusion
Very rapid onset of action, within few minutes

Short duration of action, half-life 40 minutes

The Fourth Report on the Diagnosis, Evaluation,

and Treatment of High Blood Pressure in Children
and Adolescents, Pediatrics 2004

Management of hypertensive crisis

Sodium nitoprusside

0.5-10 mcg/kg/min IV drip

Onset within 2 minutes
Duration < 10 minutes

The Fourth Report on the Diagnosis, Evaluation,

and Treatment of High Blood Pressure in Children
and Adolescents, Pediatrics 2004

PROGNOSIS
Excellent

Survival rate up to 95% in APSGN cases

Only 1% will become RPGN
Low recurrent rate but might happen ec other
nephrogenic strain of Streptococcus

Kasahara T, Hayakawa H, Okubo S. Okugawa T. Kabuki N. Tomizawa S, dkk. Prognosis of acute poststreptococcal
glomerulonephritis is excellent in children, when adequately diagnosed. Pediatr Int. 2001;43:364-67.

TAKE HOME MESSAGES

Exclude diseases other than glomerulonephritis.
The presence of a post- infectious process is
suggested by a clinical history of infection,
laboratory evidence of recent infection, and the
presence of transiently decreased activation of
complement via the alternative pathway.

If the diagnosis remains inconclusive, biopsy can aid

the final inference.

Thank You