Abstract: PUB175
The Importance of Post-Streptococcal Glomerulonephritis (PSGN) as an Etiology of AKI in Older Adults
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Berrian, Katherine N., University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States
- Arora, Simrat, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Lentz, Sarah R. C., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Briggs, Heather, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
Introduction
Post-streptococcal glomerulonephritis (PSGN) is an immune complex mediated glomerular disease that follows pharyngeal or cutaneous group A Streptococcus infections. It presents with microscopic hematuria, proteinuria, edema, hypertension, and acute kidney injury. Although traditionally a childhood disease and more prevalent in resource limited areas, an epidemiologic shift has been noted with an increasing proportion of cases in adults aged 65 or older who often carry a worse prognosis, including decreased renal recovery and higher risk of acute mortality. We report a case of PSGN secondary to Streptococcus pyogenes bacteremia in an 81 year old male in the United States, highlighting the increased risk, clinical features, and outcomes of PSGN in this population.
Case Description
An 81 year old male admitted for Streptococcus pyogenes pneumonia complicated by bacteremia and empyema was initially found to have a pre-renal AKI that resolved with fluid resuscitation. Patient was also found to have difficulty initiating a swallow leading to aspiration risk, so was started on nasogastric tube feeding.
Approximately one week later, the patient developed an AKI with peak serum creatinine at 1.68 mg/dL, from baseline of 0.71. Examination was notable for hematuria and bilateral lower extremity pitting edema, without underlying cardiac, liver, or renal etiologies. Urine studies were notable for 164 mg/dL protein, 31-75 RBCs/HPF, 11-30 hyaline casts/LPF. Labs were notable for low total complement, C3, and C4 levels (33.92 U/mL, 58 mg/dL, 18.7 mg/dL respectively). Serologies were positive for antistreptolysin O (ASO) antibodies at 1002 IU/mL (normal ≤ 200) and anti-DNase B antibodies at 2,480 U/mL (normal ≤ 259). Renal ultrasound was negative for hydronephrosis.
Patient was treated with 6 weeks of IV ceftriaxone therapy, with clinical and renal function improvement back to baseline.
Discussion
This case illustrates the importance of consideration of PSGN as a potential cause of AKI in older adults, especially the subpopulation at higher risk of worse prognosis including adults with prolonged hospitalizations, multiple comorbidities. PSGN is often overlooked due to its predominance in children in resource limited settings, and other potential sources of AKI (hypotension, medications, obstruction). Further studies are needed to investigate the epidemiologic shift to identify host susceptibility factors.