Abstract: SA-PO0720
Post-Strep Fallout: Severe Post-Streptococcal Glomerulonephritis (PSGN) After Streptococcal Bacteremia in an Adult
Session Information
- Glomerular Diseases: Complement-Mediated Glomerulopathies and Infection-Related GN
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Arumanayagam Selvaraj, Ajay, University of Illinois Chicago, Chicago, Illinois, United States
- Amtul, Raheem Raazia, Kakatiya Medical College, Warangal, Telangana, India
- Maddala, Midhuna, Kakatiya Medical College, Warangal, Telangana, India
- Amarah, Amatur R., University of Illinois Chicago, Chicago, Illinois, United States
Introduction
Adults with recent streptococcal infection remain at risk for severe PSGN, sometimes progressing to RPGN. Although PSGN usually follows skin or respiratory infections, this case is notable for occurring after streptococcal bacteremia. A high level of clinical suspicion is essential for timely recognition and treatment.
Case Description
61 year old man presented with weakness and fever for 48 hours. Blood cultures grew Streptococcus pyogenes, likely from intranasal cocaine use. His initial AKI resolved with fluids, but 6 days later he developed a new AKI with hematuria and proteinuria. Biopsy showed immune complex glomerulonephritis consistent with PSGN, with ASO titer of 2170. He received pulse steroids before confirmation. Creatinine peaked at around 8 mg/dL and returned to baseline over the next 2 weeks.
Discussion
PSGN is a type III hypersensitivity reaction caused by immune complex deposition after infection with group A β hemolytic streptococci. In adults it is relatively rare and more so after bacteremia, usually occurring in older or immunocompromised patients, especially those with diabetes or alcohol use disorder. Clinical features include acute hematuria, proteinuria, edema, hypertension, and AKI, which may progress to RPGN. Diagnosis requires evidence of recent streptococcal infection (positive ASO titer or culture). Labs typically show low C3/C4. Urine microscopy reveals a nephritic sediment with dysmorphic RBCs and RBC casts. Adults often need a kidney biopsy, especially when RPGN is suspected. Management is mainly supportive after infection eradication. Steroids may help in severe or non resolving cases by reducing inflammation. Prognosis is poorer in adults than children, with 30–50% developing chronic hypertension or CKD.