A refresher on the primary care and public health management of acute post-streptococcal glomerulonephritis

Abstract

BACKGROUND: Acute post-streptococcal glomerulonephritis (APSGN) is an acute autoimmune kidney condition triggered by skin infection or pharyngitis caused by specific strains of Streptococcus pyogenes (Group A streptococcus). In Australia, APSGN is primarily a disease of childhood disadvantage. OBJECTIVE: The aim of this review is to draw attention to a preventable childhood condition, detailing the clinical presentation, diagnostic pathway and management. DISCUSSION: Children typically present with a nephritic clinical picture: oedema, painless haematuria and hypertension. Diagnostic confirmation requires specific laboratory findings or both clinical and laboratory suggestive evidence. 'Probable' cases only require clinical evidence and 'possible' cases only require suggestive laboratory evidence. Treatment is largely supportive, focusing on the management of hypertension and fluid overload. Suspected and confirmed cases must be notified immediately to regional public health authorities. Outbreaks require a broad-based public health response in accordance with state-based guidelines.