Prevention of Post-Infectious Glomerulonephritis (PIGN) in Pediatric Patients
The primary prevention strategy for PIGN is prompt antibiotic treatment of streptococcal infections (pharyngitis and impetigo) and use of systemic antimicrobials during community outbreaks to eliminate nephritogenic strains of Streptococcus pyogenes. 1
Primary Prevention Strategies
Antibiotic Treatment of Streptococcal Infections
- Treat all confirmed or suspected streptococcal pharyngitis and impetigo promptly with penicillin (or erythromycin if penicillin-allergic) to reduce the antigenic load and prevent progression to PIGN. 1
- First-generation cephalosporins (such as cephalexin) are effective alternatives for streptococcal skin and soft tissue infections when penicillin allergy exists. 1
- Co-amoxiclav (amoxicillin/clavulanate) provides excellent coverage against streptococcal organisms and is an appropriate alternative. 1
Community-Level Interventions
- During outbreaks of PIGN, implement systematic antimicrobial treatment programs to eliminate nephritogenic strains of Streptococcus pyogenes from the community. 1
- This population-based approach is particularly important in endemic areas or during epidemic situations. 1
Critical Pitfall to Avoid
Antibiotics do NOT prevent acute glomerulonephritis once the immune response has been triggered—they only reduce antigenic burden and prevent spread to others. 1 The latent period between streptococcal infection and PIGN onset is typically 1-3 weeks for pharyngitis and 4-6 weeks for impetigo, meaning the immune-mediated kidney injury may already be underway by the time treatment is initiated. 1, 2
Secondary Prevention: Early Recognition
High-Risk Populations Requiring Vigilance
- Children with recent pyodermas (most common preceding infection, occurring in 80.6% of cases). 3
- Children with recent upper respiratory infections (5.6% of cases). 3
- Patients with concurrent infections such as varicella, pneumonia, or other bacterial infections. 3
Clinical Monitoring After Streptococcal Infections
- Monitor for signs of nephritic syndrome: hematuria (gross or microscopic), edema, hypertension, and oliguria. 1, 4
- Obtain urinalysis 1-3 weeks after pharyngitis or 4-6 weeks after impetigo if any concerning symptoms develop. 1
- Check serum C3 complement levels if glomerulonephritis is suspected; low C3 with normal C4 is characteristic of PIGN. 1
Vaccination Considerations
While no specific vaccine prevents PIGN, general infection prevention measures are important:
- Ensure pneumococcal vaccination is current to reduce risk of serious bacterial infections. 5
- Provide annual influenza vaccination to children and household contacts. 5
- These recommendations are particularly relevant for children who develop PIGN and require immunosuppressive therapy for complications. 5
Prognosis and Long-Term Monitoring
- Most children with PIGN achieve complete spontaneous resolution with excellent long-term outcomes. 4, 6
- However, 31.9% may have evidence of residual renal injury at discharge, requiring follow-up. 3
- If C3 complement levels remain low beyond 8-12 weeks, perform kidney biopsy to exclude C3 glomerulonephritis, which requires different management. 1, 7
- At 6-month follow-up, monitor for persistent microalbuminuria or hematuria. 3
Special Circumstances
Non-Streptococcal PIGN
- Recognize that non-streptococcal organisms (particularly Staphylococcus in adults) are emerging as important causes of PIGN in high-income countries. 2, 6
- Pneumonia, mumps, and other bacterial infections can cause PIGN in approximately 10% of cases. 3
- IgA-dominant infection-related glomerulonephritis is increasingly common in older patients with staphylococcal infections. 1