What are potential complications 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

An occasional patient develops pulmonary edema because of the marked increase in vascular volume that is present in the early phase of the disease.

Congestive heart failure is rare but has been reported. Definite myocarditis has also been documented.

In most patients with moderate to severe APSGN, a measurable reduction in volume of glomerular filtrate (GF) is present, and the capacity to excrete salt and water is usually diminished, leading to expansion of the extracellular fluid (ECF) volume. The expanded ECF volume is responsible for edema and, in part, for hypertension, anemia, circulatory congestion, and encephalopathy. Persistence or worsening of azotemia is always troubling and may suggest acute kidney injury. The presence of acute kidney injury may suggest an alternate diagnosis (eg, membranoproliferative glomerulonephritis [MPGN], Henoch-Schönlein purpura [HSP], systemic lupus erythematosus [SLE]) or a severe or worsening APSGN, such as observed in those with crescentic glomerulonephritis or rapidly progressive glomerulonephritis. [43]

The renal survival of APSGN in the developed world is significantly worse than in the epidemic form of APSGN seen in the developing world. A third to two third of patients in the developed world develop chronic kidney disease that may progress to end-stage kidney disease. These outcomes may be influenced by the susceptibility of patients in developed countries, who are usually old and have comorbidities.


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