What is the role of urine studies 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

Urine output is most often reduced in acute glomerulonephritis, and the urine is concentrated and acidic. Glucosuria occurs occasionally, and proteinuria is commonly present.

Proteinuria rarely exceeds 3+ by dipstick, corresponding to fewer than 2 g/m2/d when assessed quantitatively. Approximately 2-5% of children with acute poststreptococcal glomerulonephritis (APSGN) have massive proteinuria and a nephrotic picture.

Hematuria is the most consistent urinary abnormality, although histologic findings consistent with acute poststreptococcal glomerulonephritis (APSGN) have been reported in children who had no or minimal urinary abnormalities.

Polymorphonuclear leukocytes and renal epithelial cells are common in the urine of patients with poststreptococcal acute glomerulonephritis, particularly during the early phase of the disease. In addition, hyaline and/or cellular casts are almost always present.

Red blood cell casts have been found in 60-85% of hospitalized children with APSGN. These casts, although characteristic of a glomerular lesion, are often not detected, because the urine is not fresh or is examined by an inexperienced person.


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