Synopsis
Recognise infection-related immune-complex glomerulonephritis, distinguish a latent post-streptococcal presentation from ongoing infection, and provide supportive renal care without missing sepsis or an alternative complement disorder.
- Infection-related glomerulonephritis may follow a resolved infection or occur while infection remains active; the latter is increasingly important in older adults, diabetes and frailty.
- Classic post-streptococcal disease follows pharyngitis after roughly one to three weeks or skin infection after about three to six weeks rather than occurring simultaneously.
- Haematuria, oedema, hypertension, reduced eGFR and variable proteinuria form the nephritic pattern; nephrotic-range protein loss can occur and does not exclude the diagnosis.
Key red flags
Persistent fever, new murmur, embolic lesions, splenomegaly, weight loss or implanted cardiac material requires blood cultures and an endocarditis pathway before immune treatment.
Investigation priorities
Identify glomerular haematuria, red-cell casts and the amount and character of protein loss.
Management branches
Haematuria, oedema, hypertension and AKI appear after or during an infection.
- Assess ABCDE, pulmonary oedema, blood pressure, potassium, acid–base state and urine output, treating immediate renal emergencies and involving nephrology early.
- Send microscopy, quantitative protein, complement, cultures and exposure-directed serology, and examine carefully for skin, dental, cardiac, bone, line or prosthetic infection.
Key medicines
Source-directed antibioticChoose agent, route and duration through local microbiology guidance, cultures, source and current renal dosing.
Loop diureticTitrate the local oral or intravenous regimen to congestion, diuretic exposure, perfusion and kidney response.