Acute glomerulonephritis has a clear age-related presentation and prognosis. In children and young adults, acute glomerulonephritis is often associated with recent streptococcal infection, producing hematuria, heavy proteinuria, edema, hypertension, and in many cases, the development of pulmonary congestion. The prognosis is generally good in poststreptococcal disease but variable in nonnoslslreptococcal cases.
In elderly patients, Ihe nonspecific clinical features (such as nausea, malaise, arthralgias, and a striking predilection for pulmonary infiltrates initially) are thought to represent worsening of a preexisting illness, especially heart failure. Proteinuria is generally moderate. Hypertension or edema, although unusual, indicates a streptococcal cause, more often a pyoderma! streptococcal infection rather than pharyngitis; the prognosis is favorable. Otherwise, the prognosis is poor, with crcscentic glomerulonephritis associated with focal, segmental, necrotizing, or fibrosing glomerulus the most common histologic finding.
The value of treatment with corticosteroids, immunosuppressive agents, anticoagulants, and plasmapheresis remains controversial. In view of the poor prognosis of rapidly progressive glomerulonephritis in the elderly, the potential benefits of high-dose pulse corticosteroid therapy are likely to outweigh the risks.