When is renal biopsy indicated in the workup of acute poststreptococcal glomerulonephritis (APSGN)?

Updated: Dec 16, 2020
  • Author: Duvuru Geetha, MD, MRCP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Atypical features in the early phase of APSGN that suggest the need for kidney biopsy include the following:

  • Absence of the latent period between streptococcal infection and acute glomerulonephritis
  • Anuria
  • Rapidly deteriorating renal function
  • Normal serum complement levels
  • No rise in antistreptococcal antibodies
  • Extrarenal manifestations of systemic disease
  • No improvement or continued decrease in the glomerular filtration rate at 2 weeks
  • Persistence of hypertension beyond 2 weeks

Atypical features in the recovery phase that mandate a kidney biopsy include the following:

  • Failure of glomerular filtration rate to normalize by 4 weeks
  • Persistent hypocomplementemia beyond 6 weeks
  • Persistent microscopic hematuria beyond 18 months
  • Persistent proteinuria beyond 6 months

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