What is the role of kidney biopsy in the workup 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

Kidney biopsy is generally not recommended in the evaluation of patients with APSGN since the clinical history is usually highly suggestive and resolution of APSGN typically begins within 1 week of presentation. However, the performance of a renal biopsy is indicated in patients whose clinical presentation, laboratory findings, or disease course is atypical. In such persons, study of the histology by light, immunofluorescent, and electron microscopy may be diagnostic. Indications for kidney biopsy include the following:

  • Failure to document a recent streptococcal infection by a rise in ASO or streptozyme titer

  • Normocomplementemia

  • Renal insufficiency, especially if the glomerular filtration rate remains less than 30 mL/min/1.73 m2 for more than 1 week

  • Persistently low complement (C3) levels beyond 6-8 weeks, without resolution of features of acute glomerulonephritis.

  • Recurrent episodes of hematuria, especially frank hematuria


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