History
The presentation in patients with postinfectious glomerulonephritis (PIGN) may vary from asymptomatic hematuria to a full-blown acute nephritic syndrome consisting of proteinuria, edema, hypertension, and renal failure. Hematuria may be gross or microscopic and edema may be present. Patients may report fever, night sweats, and rigors. Weight loss is a possible complaint and patients may report arthralgias. Abdominal, chest, or back pain may be caused by a visceral abscess.
Patients may have history of shunt placement for hydrocephalus, or they may have a vascular graft that has become infected.
Patients with hepatitis B or C may have a history of intravenous drug abuse, needle stick injury, blood transfusions, or sexual promiscuity.
Patients with HIV infection may have history of intravenous drug abuse, hemophilia, receipt of blood transfusion from 1977-1985, unprotected sex with multiple partners, or tuberculosis.
Physical Examination
Hypertension may be due to kidney failure. Edema due to nephrotic syndrome is unusual but can develop in as many as 30% of cases associated with shunt nephritis. Rash may be maculopapular or purpuric. Lymphadenopathy is a reported finding. Hepatosplenomegaly may be palpable.
Findings of subacute bacterial endocarditis (SBE) may include the following:
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Heart murmur
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Purpura
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Roth spots
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Janeway lesions
Tables
| Bacterial | Viral | Protozoal |
|---|---|---|
| Staphyloccoccus aureus, S epidermidis, S albus | Hepatitis (A, B, C, E) | Plasmodium malariae, P falciparum, P vivax |
| Streptococcus pneumoniae, S viridans, S pyogenes | Human immunodeficiency virus | Leishmania donovani |
| Mycobacterium leprae, M tuberculosis | Epstein-Barr virus | Toxoplasma gondii |
| Treponema pallidum | Hantavirus | Trypanosoma cruzi, T bruci |
| Salmonella typhi, S paratyphi, S typhimurium | Coxsackie B | Toxocara canis |
| Leptospira species | Echovirus | Strongyloides stercoralis |
| Yersinia enterocolitica | Cytomegalovirus | |
| Neisseria meningitidis, Neisseria gonorrhoeae | Varicella zoster | Helminthic |
| Corynebacterium diphtheriae | Mumps | Schistosoma mansoni, S japonicum, S haematobium |
| Coxiella burnetti | Rubella | Wuchereria bancrofti |
| Brucella abortus | Influenza | Brugia malayi |
| Listeria monocytogenes | Dengue | Loa loa |
| Parvovirus | Onchocerca volvulus | |
| Syphilis | Trichinella spiralis | |
| SARS-CoV-2 (COVID-19) | ||
| Fungal | ||
| Histoplasma capsulatum | ||
| Candida | ||
| Coccidiodes immitis |
