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Post-Streptococcal GN — RACP Adult Medicine MCQ

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EasyNephrologyPost-Streptococcal GNRACP Adult Medicine

A 10-year-old boy presents 2 weeks after a streptococcal pharyngitis with haematuria (cola-coloured urine), periorbital oedema, and hypertension. Urinalysis shows dysmorphic RBCs and RBC casts. C3 is very low, C4 is normal. ASO titre is elevated. Creatinine is mildly elevated. What is the most likely GN?

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Correct answer: C — Post-streptococcal glomerulonephritis

Nephritic syndrome (haematuria, hypertension, oedema) 1-3 weeks AFTER streptococcal infection with low C3 (normal C4 — alternative pathway activation), elevated ASO, and RBC casts is post-streptococcal GN. Key timing: PSGN occurs 1-3 weeks AFTER pharyngitis (vs IgA nephropathy which is synpharyngitic — concurrent with URTI). Usually self-limiting in children (>95% recover). Supportive treatment: salt/fluid restriction, antihypertensives, diuretics. Biopsy only if atypical features.

Reference: KDIGO – 2021 – GN; eTG Nephrology 2024