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Hello You Are Smart Doctor And A Positive Manner Looking

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Posted on Tue, 30 Aug 2022
Question: hello
You are smart doctor and a positive manner looking on things !

I have question about post Streptococcus Glomerulonephritis
There is article about follow up after infection - 10 years follow up - test was similar to control group

Comparisons of clinical and renal function aspects of 60 patients and 48 community controls have not shown significant differences (eGFR <60 ml/min/1.73m2 and/or albuminuria >30mg/g creatinine: 13.8% vs. 12.2%, respectively, p = 0.817)

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0000#pone-0000-t002


None of the patients had nephrotic syndrome. Increased albuminuria (>30 mg/g) was detected in 12% of the cases (n = 6 had values between 30–100 mg/g creatinine

1. Increased albuminuria - is it level in urine test, beceause in methode it is said (They underwent clinical and renal function evaluation, including serum creatinine)

it is this measure ?
https://www.kidney.org/content/kidney-failure-risk-factor-urine-albumin-to-creatinine-ration-uacr


2 So if it is in urine - as i understand it is from high blood pressure - the method how to treat it is lower blood pressure by medicine !
As it is said in these article that treatment is key to reduce - albuminuria - so early treatment and lifestyle management will decrease albuminuria ? It seams logic !

Can you reverse microalbuminuria?
Yes, your level of albumin may return to normal after you get treatment and may stay at a normal level for years. If you start treatment and make lifestyle changes straight away, you’ll have a better chance of reversing any damage to your kidneys from microalbuminuria, or at least slow down its progression.

Thank you very much




doctor
Answered by Dr. Aaron Branch (11 hours later)
Brief Answer:
Albuminuria is detected by urine testing

Detailed Answer:
Hello, I'm Dr. Branch, thanks for using 'Ask a Doctor'. It's good to hear from you again and thank you for requesting me. If I am understanding your question correctly, the increased albuminuria, means albumin in the urine, and the units they use (mg/g) indicates they are using an albumin to creatinine ratio, as you suspected.

It is true that blood pressure is important in managing albuminuria, and treating high blood pressure is very important. Your last statement is correct in that the level of albuminuria can return to normal if the blood pressure is controlled and the cause of the albuminuria is corrected.

I hope that helps, please let me know if you have any other questions about that, and I would be glad to discuss it with you further.
Above answer was peer-reviewed by : Dr. Saisudha Kotla
doctor
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Follow up: Dr. Aaron Branch (9 hours later)
Thank you very much for positive answer !

i have question about Post-Streptococcal Glomerulonephritis - caused by nephritogenic strains of Streptococcus

1. Does very one who is colonized wit the nephritogenic strains of Streptococcus get infections like pharyngitis or skin infections, because you can be colonized- it does not mean that you will get infection - and you get Post-Streptococcal Glomerulonephritis after getting - through or skin infection
in literature:

10% to 15% attack rate of PSGN following throat or skin infection with a nephritogenic strain of group A strep
https://www.cdc.gov/groupastrep/diseases-hcp/post-streptococcal.html

2. In rare situation Post-Streptococcal Glomerulonephritis is caused without throat or skin infection - but i understand it is very rare - is it so ?

However; some patients develop PSGN without experiencing symptoms of respiratory tract infection or pyoderma, which can be a diagnostic challenge.

https://www.ncbi.nlm.nih.gov/books/NBK538255/

3. Approximately 50% of children with PSGN are asymptomatic it is said in literature

https://www.ncbi.nlm.nih.gov/books/NBK538255/

So these patients are not likely to have any complications from PSGN - logic



4. How long are you colonized with nephritogenic strains of Streptococcus - some time, like some mounts - and then you could be natural clean bacteria from your body ?
Because for example MRSA Staphylococcus is pushed out by simple Staphylococcus, because MRSA is mutant !
It could be also with nephritogenic strains of Streptococcus - that simple Streptococcus push out nephritogenic strains


5. But as we both are positive way of thinking - even you are colonized with nephritogenic strains of Streptococcus the risk of mortality is rather low for example mathematics
100 % get infection of nephritogenic strains of Streptococcus 10 % get PSGN and from literature morality is 2 - 10 %, then 10 % split 10 - the overall nephritogenic strains mortality risk is 1 %, and others are likely to recover as first article about 10 years follow up what i sent to you.

Thank you very much !

And have a nice day

doctor
Answered by Dr. Aaron Branch (15 hours later)
Brief Answer:
See my answers below

Detailed Answer:
1. My understanding is that just being colonized with Streptococcus will not cause Post-Streptococcal glomerulonephritis, as the glomerulonephritis depends on the immune response to the infection. Simply being colonized will by definition not cause an infection and immune response, and so glomerulonephritis should not occur.

2. Yes, I do believe that is quite rare.

3. Yes, I agree, if they do not have symptoms, complications would be unlikely.

4. I could not find any clear information about how long one could be colonized by nephritogenic strains of Streptococcus, and it may be that we do not know the answer to that question at this time.

5. I would agree that the risk even from nephritogenic strains of Streptococcus would be very low, much lower than 1% I believe. Mortality would be related to kidney failure or heart failure from PSGN. I'm not sure if you are just assuming that 100% of people will be infected with nephritogenic strain of Streptococcus, but of course in the real world not everyone will get this infection.

Please let me know if you have any other questions, I'd be glad to help any way I can.
Above answer was peer-reviewed by : Dr. Saisudha Kotla
doctor
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Follow up: Dr. Aaron Branch (15 hours later)
Thank you for answer !

1. About first question - how much from % of nephritogenic strains of Streptococcus - will get strep infection at first - without PSGN, im trying to understand how much % could get some infection and then are at risk for PSGN as the first step is to get strep infection - and only after PSGN

2. About 4th question - i also dont know - but it seems logic that nephritogenic strains of Streptococcus it clears after some time, as PSGN are rather rare - if it was not, than we could see that it is overtaking simple A strep, and we could see PSGN pandemic - but we dont - and it seems logic that clears by its own over the time.

3. The 5th question was just example - if there is situation of 100 people of nephritogenic strains
Streptococcus and they get strep through then 10 will get PSGN - as it said in literature that 10 % of nephritogenic strains get PSGN - and if mortality is about 10 % that 10 / 10 = 1 %

So mathematics logic if 100 people who get strep trough of nephritogenic strains - risk of mortality from PSGN will be only 1 %

Than you very much


doctor
Answered by Dr. Aaron Branch (16 hours later)
Brief Answer:
See my response below

Detailed Answer:
1. I just want to clarify, are you asking what percentage of people who are colonized with nephritogenic strains of Streptococcus will get strep infection?

4. Yes, that is possible, though sometimes what we think logically makes sense is not how it works in the real world, ideally we would have some evidence, which I do not believe is available. But it may be as you say.

5. Yes, you are right, if 10% of people who are infected with nephritogenic strains of Streptococcus will get PSGN, and mortality is 10% (which is within the range I have seen, though this would be mostly in adults), then 1% of people infected with nephritogenic strains of Streptococcus would be expected to die. However, I notice that you get the 10% figure from the CDC article, which cites a 1960s study. I wonder if with better treatment with antibiotics this would be much lower now.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Dr. Aaron Branch

General & Family Physician

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Hello You Are Smart Doctor And A Positive Manner Looking

Brief Answer: Albuminuria is detected by urine testing Detailed Answer: Hello, I'm Dr. Branch, thanks for using 'Ask a Doctor'. It's good to hear from you again and thank you for requesting me. If I am understanding your question correctly, the increased albuminuria, means albumin in the urine, and the units they use (mg/g) indicates they are using an albumin to creatinine ratio, as you suspected. It is true that blood pressure is important in managing albuminuria, and treating high blood pressure is very important. Your last statement is correct in that the level of albuminuria can return to normal if the blood pressure is controlled and the cause of the albuminuria is corrected. I hope that helps, please let me know if you have any other questions about that, and I would be glad to discuss it with you further.