Acute postinfectious glomerulonephritis in children

Abstract

Postinfectious glomerulonephritis (PIGN) comprises a large group of glomerulonephridities that are caused by infectious agents. Acute glomerulonephritis is a term that defines a pathological lesion that may be asymptomatic or it may be manifested clinically with the acute nephritic syndrome, or the nephrotic syndrome, or with a rapidly progressive renal failure. In this chapter we will deal with the most common glomerulonephridities that result from bacterial infections: poststreptococcal glomerulonephritis, IgA-dominant glomerulonephritis associated with staphylococcal infections, and glomerulonephritis associated with bacterial endocarditis, infected atrial ventricular shunts, syphilis, and deep-seated infections. Since poststreptococcal glomerulonephritis is the best known of the acute postinfectious glomerulonephritis and its most frequent clinical picture is the acute nephritic syndrome, the terms poststreptococcal glomerulonephritis, acute glomerulonephritis, and acute nephritic syndrome are often, and incorrectly, used interchangeably. The incidence of PIGN is declining in affluent societies where most cases now occur in elderly individuals, many with comorbid debilitating conditions such as alcoholism, HIV infection, drug abuse, and diabetes. Nevertheless, PIGN, and specifically poststreptococcal glomerulonephritis, is still frequent in children in poor communities with limited access to medical care.