countries Many organisms including Staphylococcus sp , Pneumococcus, Salmonella typhi, Klebsella pneumoniae, and E coli may be causative In regards to streptococcal-related nephritis, the latent period from infection to acute poststreptococcal glomerulonephritis (APSGN) is generally to weeks after pharyngitis and to weeks with skin infections It most often affects children aged to 14 years old, and rarely occurs in children less than years old Males are more often affected In recent decades, the prevalence of APSGN has declined in most industrialized nations, although it persists at high rates in some developing countries The clinical presentation of APSGN may vary from asymptomatic microscopic hematuria to an abrupt onset of nephritic syndrome Subclinical APSGN is four to five times more common than an acute clinical presentation, which can be associated with gross hematuria, proteinuria, oliguria, edema, and hypertension Hypertension can be severe and evolve into hypertensive emergency, which typically affects the CNS in children Symptoms include headache, seizure, and encephalopathy Clinical assessment A detailed history and physical examination should be completed when there is a suspicion of APSGN The color and quantity of urine output should be assessed by history A history of a preceding streptococcal infection may be present, although the infection may not have been identified at the time The physical examination should assess for the consequences of APSGN The patient should be evaluated for signs of fluid overload including hypertension, and the signs and symptoms of hypertensive crisis should be addressed Laboratory studies during a typical episode of APSGN reflect a nephritis with activation of the alternative complement pathway Serum studies may demonstrate reduced renal function Associated electrolyte abnormalities include hyponatremia, reflecting an inability to excrete water, and hyperkalemia The majority of patients have a low C3 complement, and a normal C4 complement The C3 level normalizes in to weeks If the C3 remains depressed after months or the C4 is low, diagnostic considerations include chronic forms of glomerulonephritis, including membranoproliferative glomerulonephritis (MPGN) and lupus nephritis If the complement levels are normal at presentation, APSGN is less likely, and IgA nephropathy would be a consideration