Acute postinfectious glomerulonephritis. Case report

Abstract

A case of acute post-infectious glomerulonephritis is presented in an adult patient, which is rare at this age. It is an immunologically mediated pathological syndrome with glomerular injury in response to an extrarenal infection. It is caused by viral, fungal, parasitic, and bacterial pathogens; the one responsible for the highest number of cases is group A beta-hemolytic streptococcus, which causes a pharyngeal or cutaneous infection, occurring approximately thirty days before the onset of renal symptoms. The lesion manifests as a predominantly glomerular, non-suppurative inflammatory condition with an immunological basis, where humoral and cellular immunity play a key role in renal injury. The clinical presentation varies, from oligosymptomatic patients to acute nephritic syndrome; rarely, nephrotic syndrome, and, exceptionally, rapidly progressive forms. A recent, identifiable infectious disease usually precedes postinfectious acute glomerulonephritis. Gross hematuria, proteinuria, hypertension, and edema are the most frequent clinical manifestations, with acute hypocomplementemia in most cases. The outcome is generally favorable, although severe forms can progress to chronic kidney disease. The paradigm of postinfectious acute glomerulonephritis is post-streptococcal glomerulonephritis, and its most characteristic clinical presentation is nephritic syndrome. It has an excellent prognosis, especially in children, with complete recovery occurring in more than 95% of cases; in adults, a high percentage develops end-stage kidney disease. Mortality in the acute phase of the disease can be avoided through proper treatment of acute kidney failure, heart failure, and hypertension.