Acute Post-Streptococcal Glomerulonephritis (APSGN)
Post-Streptococcal Immune Complex Glomerulopathy
Primary risk age: 5 to 12 Years (Rare under 3 years)
- Urgency
- Severe
- Typical age
- 5 to 12 Years (Rare under 3 years)
- Body system
- Renal & Urological
Typical course: Oliguria and edema resolve within 1 to 2 weeks; hematuria may take several weeks, and microscopic hematuria can persist for up to a year.
Reviewed against AAP · CDC · WHO · NHS guidance Last reviewed 2026-06-13
1. Summary & Pathophysiology
Post-Streptococcal Immune Complex Glomerulopathy
Pathophysiology (Development Path)
Streptococcal antigens bind to glomerular structures, prompting the formation of antigen-antibody immune complexes. These complexes deposit in the subepithelial space of the glomerular basement membrane, activating the complement cascade. This recruits neutrophils, causing glomerular inflammation, a drop in glomerular filtration rate (GFR), and fluid retention.
Primary Causes & Etiology
An immune-mediated reaction following pharyngeal or skin infection (impetigo) with nephritogenic strains of Group A Beta-Hemolytic Streptococcus.
2. Symptom Continuum
- Early Onset Signs
A history of a sore throat 1 to 2 weeks prior, or skin sores 3 to 6 weeks prior, followed by the appearance of mild periorbital edema.
- Progressive Phase
Gross hematuria: urine appears tea-colored, smoky, or cola-colored. Mild to moderate oliguria (reduced urine output) and mild hypertension.
- Severe Indicators
Severe volume overload leading to acute hypertensive encephalopathy (marked by headache, seizures, or confusion) and pulmonary edema.
3. Clinical Verification
Urinalysis showing dysmorphic red blood cells, RBC casts, and mild-to-moderate proteinuria. Serum complement level C3 is characteristically low. Elevated anti-streptolysin O (ASO) titer.
4. Care & Elements Plan
Primary Care Treatment Plan
Supportive management focusing on fluid restriction, sodium-restricted diet, and management of hypertension. Eradicate any remaining streptococcal infection with antibiotics.
Home Support Elements
Monitor and restrict daily fluid intake as advised. Weigh the child daily to monitor fluid retention. Avoid adding sodium to meals.
Generic Active Ingredients (No Brands)
- Furosemide (generic loop diuretic active ingredient to manage volume overload and hypertension)
- Nifedipine or Hydralazine (generic active anti-hypertensive agents for severe blood pressure spikes)
- Penicillin V (to eradicate remaining GAS bacteria).
Lists active elements only. Never administer self-designed therapies.
5. Doctor Critical Lines
Critical Thresholds: When to See a Doctor
Seek prompt care if a child develops tea-colored urine, facial puffiness, a significant decrease in urine output, or a severe headache weeks after a sore throat or skin infection.
6. Vaccine & Prevention
Routine Prophylaxis (Prevention)
Prompt and complete antibiotic treatment of all Group A Streptococcal infections.
Immunization Context
No vaccine is available targeting Group A Streptococcus.
7. Timelines & Outlook
Active Timeline
Oliguria and edema resolve within 1 to 2 weeks; hematuria may take several weeks, and microscopic hematuria can persist for up to a year.
Expected Prognosis
Excellent. Over 95% of children achieve complete recovery with normal renal function restored. Long-term renal damage is extremely rare in pediatric patients.
Potential Untreated Complications
Acute renal failure, hypertensive crisis, hypertensive encephalopathy, and congestive heart failure.
More in Glomerular Boundary Filtration Pathology
Severe Minimal Change Disease (Pediatric Nephrotic Syndrome)
Glomerular Podocyte Barrier Dysfunction Syndrome
2 to 7 Years (Accounts for over 85% of childhood nephrotic cases)
Emergency Hemolytic Uremic Syndrome (HUS)
Serious condition combining red-cell destruction, low platelets, and acute kidney injury.
Most common in children under 5 years.