What are the signs and symptoms of acute poststreptococcal glomerulonephritis (APSGN)?

Updated: Dec 05, 2018
  • Author: Rajendra Bhimma, MBChB, MD, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal); Chief Editor: Craig B Langman, MD  more...
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Answer

The classic triad of gross hematuria, edema, and hypertension are the most common presenting symptoms.  However, some patients may have a subclinical presentation with microscopic hematuria, minimal or no edema, and normal or just mildly elevated blood pressure.  Hematuria is almost a universal finding with about one third of patients having gross hematuria. The dark urine is due to the oxidation of hemoglobin that turns brown after a prolonged time in an acidic environment.  Gross hematuria may last up to 10 days and recur after a febrile illness. Edema occurs in about 65 -90% of patients and ascites is typically absent. Edema tends to last between 7-10 days.  Pulmonary edema is uncommon except in the very severe cases.  Hypertension occurs in about 60-80% of cases, present in the acute phase of the disease and is usually transient, lasting about 10 days. Hypertensive encephalopathy has been reported in about 11% of patients untreated in developing countries. Scanty urine or oliguria is seen in less than 50% of patients.  Nonspecific symptoms included malaise, weakness, nausea and dull flank pain. 

Recent poststreptococcal infection is most commonly demonstrated by serologic markers for elevated antibodies to extracellular streptococcal antigens.


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