What are the laboratory diagnosis procedures for Acute PostStreptococcal

Glomerulonephritis (APSGN) ?
Group A streptococcus (GAS) is the cause of a wide range of acute suppurative and,
following a latent period, non-suppurative diseases such as rheumatic fever and
poststreptococcal glomerulonephritis. Hence, diagnosis of the latter group requires
evidence of preceding GAS infection. The bacteria produce a range of extracellular
antigens, including streptolysin O, which induce an antibody response in the host. A
rise in antistreptolysin O titre (ASOT) is indicative of preceding GAS infection. In
clinical practice, often only a single ASOT measurement is available and its timing in
relation to a possible GAS infection is unknown. In order to optimise diagnosis of
preceding GAS infection, at least two sequential ASOT measurements, together with
simultaneous assay for anti-DNase B, a second antistreptococcal antibody, is
recommended.
Acute glomerulonephritis is defined as the sudden onset of hematuria, proteinuria,
and RBC casts. Although RBC casts are diagnostic of glomerular bleeding, they may
be difficult to find. Proteinuria in patients with acute glomerulonephritis typically
ranges from 500 mg/d to 3 g/d, but nephrotic-range proteinuria (>3.5 g/d) may be
present. A thorough history and physical examination should focus on identification
of an underlying systemic disease, and serologi evaluation should be performed for a
prompt diagnosis. The serum complement levels provide useful information; if any
component is depressed, assessment of the levels of other components may be
helpful. Initially determine the CH50 level; if results are abnormal, proceed with

evaluation of individual components (e.g., C3 and C4 levels). If an abnormality of the

alternate pathway is suspected, determine the AH50 activity. Estimation of GFR (i.e.
serum creatinine level) and quantitation of urine protein excretion (i.e., 24 hour
urine protein excretion rate or urine pnrotien: creatinine ratio) also should be
performed. If the GFR is depressed, evaluation of renal size (e.g., by ultrasound) is a
useful guide to determine the extent of fibrosis. Small kidneys (<9 cm) suggest
extensive scarring; reversibility is low in this setting, whatever the underlying
diagnosis. The presence of nephrotic-range proteinuria is more common in certain
diseases.
Firstly, to obtain the laboratory data, we should look for hematuria, with or without
proteinuria, on urine dipstick. Secondly, we should obtain fresh urine for phasecontrast microscopy to look for erythrocyte casts. Then, we should quantify
proteinuria either with a spot urine test for protein/creatinine ratio (if >2 is
significant) or 24-hour urine collection (if >2 g/24 hours is suggestive of glomerular
pathology). Thirdly, we should obtain serial serum creatinine measurements and
estimated GFR (MDRD formula) to detect the presence of and any worsening renal
insufficiency.
After obtatining the laboratory data, a detailed physical exam has to be done to look
for signs of acute nephritis and the specific etiology of the acute glomerulonephritis.
Those include signs of acute nephritis such as high blood pressure and edema. There
are also signs that suggest a specific etiology of acute glomerulonephritis such as
Infection which includes Fever, Heart murmur, Malaise, Sore throat. Lastly, a kidney

biopsy should be performed for histolopathology examination (Madaio & Harrington,

2001).
Madaio, M. P. & Harrington, J. T. 2001. The Diagnosis of Glomerular Diseases.
Acute Glomerulonephritis and the Nephrotic Syndrome. Arch Intern Med. [Online],
161:25 34

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Madaio, M. P. &
Harrington, J. T. 2001.

diagnosis

The Diagnosis of

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Glomerular Diseases.

for Acute

Acute Glomerulonephritis
and the Nephrotic

PostStrepto

Syndrome. Arch Intern

coccal

Med. [Online], 161:25

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34

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