Post Strep Glomerulonephritis: Diagnosis and Management Tips from Dr Allison Hempenstall

The Good GP

In this episode, Dr Krystyna de Lange is joined again by Dr Allison Hempenstall, a General Practitioner and Public Health Physician from Far North Queensland, to discuss acute post-streptococcal glomerulonephritis (APSGN).

Dr Hempenstall begins by defining APSGN and explaining how it is an acute autoimmune kidney condition triggered by a group A strep (GAS) infection. She elaborates on the socio-economic risk factors and the presence of nephrotoxic strains of group A strep that increase susceptibility to APSGN. Comparison is made with acute rheumatic fever, noting both similarities and differences.

Covering the classic triad of symptoms for APSGN – hypertension, haematuria, and oedema – and how to diagnose the condition through clinical presentations and laboratory investigations. Dr Hempenstall explains the importance of identifying haematuria through urine analysis and performing necessary tests for recent strep infections and complement levels (C3 and C4).

They then move to the appropriate management strategies, including the use of intramuscular penicillin for eradicating strep and symptom management through antihypertensives and fluid management. Dr Hempenstall emphasises the necessity of involving paediatricians for cases requiring hospitalisation and mentioning that any persistent hypertension in children should be addressed promptly.

Lastly, outlining longer-term follow-up protocols, stressing the importance of regular blood pressure and urine checks post-diagnosis and the role of health education in preventing future occurrences. Special attention to the importance of contact tracing and prophylactic measures for household contacts in order to curb the spread of nephrotoxic strains of group A strep.

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