Prognosis of Post-Streptococcal Glomerulonephritis
The prognosis of post-streptococcal glomerulonephritis (PSGN) is generally good with early diagnosis and appropriate antibiotic treatment of the infection, with most patients experiencing complete recovery. 1
Clinical Course and Outcomes
Short-term Prognosis
- Most children with PSGN have excellent immediate prognosis
- Acute phase manifestations typically resolve within 7-10 days 2
- Common acute complications include:
- Hypertension
- Edema
- Gross hematuria
- Temporary impairment of renal function
Long-term Prognosis
- Complete recovery occurs in approximately 85-90% of patients 3, 4
- Microscopic hematuria and proteinuria may persist in up to 10% of patients but usually resolve within 1-2 years 2
- Risk factors for poor prognosis include:
- Crescent formation on renal biopsy
- Severe renal insufficiency at presentation
- Hypoalbuminemia
- Persistent hypocomplementemia beyond 12 weeks 1
Prognostic Factors
Favorable Prognostic Indicators
- Childhood onset (better than adult onset)
- Normal renal function at presentation
- Prompt resolution of hypocomplementemia (within 8-12 weeks)
- Absence of crescents on kidney biopsy
Poor Prognostic Indicators
- Persistently low C3 in serum beyond 12 weeks (may indicate C3 glomerulonephritis) 1
- Severe disease requiring dialysis at presentation 3
- Crescentic glomerulonephritis on biopsy 5
- Nephrotic-range proteinuria 6
Long-term Monitoring
Regular monitoring of:
- Renal function tests
- Urinalysis for hematuria and proteinuria
- Blood pressure
- Complement levels (C3, C4)
Persistence of abnormalities beyond 12 weeks warrants consideration of kidney biopsy to exclude other diagnoses, particularly C3 glomerulonephritis 1
Special Populations
Children
- Generally excellent prognosis with >90% complete recovery
- Persistent urinary abnormalities may be seen in specialized tertiary care settings 3
Adults
- Slightly worse prognosis than children
- Higher risk of progression to chronic kidney disease
- Crescentic forms with nephrotic syndrome may benefit from more aggressive therapy 6
Complications and Sequelae
Acute Phase Complications
- Congestive heart failure
- Pulmonary edema
- Hypertensive encephalopathy
- Hyperkalemia
Long-term Sequelae
- Chronic kidney disease (uncommon, occurs in approximately 5-15% of cases) 3, 4
- Persistent hypertension (rare)
- Persistent urinary abnormalities (microscopic hematuria, proteinuria)
Conclusion
The overall prognosis for post-streptococcal glomerulonephritis is favorable, particularly in children. Most patients recover completely with supportive care and appropriate antibiotic treatment. However, a small percentage may develop chronic kidney disease, highlighting the importance of regular follow-up and monitoring for persistent abnormalities.