ACUTE GLOMERULO NEPHRITIS
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Acute glomerulo
nephritis is one important clinical manifestation of Glomerulonephritis.
Clinical features
comprises of
Hematuria
Protenuria
Hypertension
Azotemia
Often associated with
oedema,oliguria
Pathogenesis
:
Immunologically
mediated injury to glomeruli
Causes:
I.
Primary
glomerular diseases
II.
Secondary causes
Secondary
I.
Post
streptococcal -Group a beta hemolytic
streptococcus
II.
Non
streptococcal
Bacterial:
infective
endocarditis
Sepsis
Shunt nephritis
Salmonella infection
Viral:
HepatitisB surface antigen
Mumps
Measles
Parasitic
Malaria
III.
Multisystem Disease
Systemic sclerosis
Vasculitis
Good paustures
syndrome
Primary glomerulo nephritis
Mesangio
proliferative
Mesangio
capillary
IGA
nephropathy
Other:
Gullain
Barre syndrome
Post streptococcal glomerulo nephritis
Follows pharyngeal
infection- 5-10 days later
Follows Skin
infection-15 days later (latent period)
NOTE:
If it occurs soon after
without latent period think of exacerbation of already existing IGA
nephropathy,Burgers disease.
How do you diagnosePSGN:
By positive
Pharyngeal/skin culture
Rising titre-Anti
streptolysin O titre
Fall in levels of
compliments-C3,C4,C1q
Renal biopsy
Past history to be elicited in AGN:
H/o sore
throat,scabies,impetigo
Importance of strepto
coccal sore throat/skin infection:
Skin infection causes
onlyAGN
Throat infection causes
AGN or rheumatic fever.
Clinical features of AGN:
Children are commonly
affected
Acute onset
Puffiness of face,
oliguria, smoky urine
Where does edema start ?why?
Edema starts in
periorbital area because of low tissue pressure there.
What are important complications of hypertension?
1.hypertensive
encephalopathy
2.acute pulmonary edema
Examie the fundus to look for pappiledema-sign of hypertensive
encephalopathy.
What are other complication?
Acute renal failure
Nephrotic syndrome
Chronic glomerulo
nephritis.
Susceptibility to
infection
Note:
Oliguria is urine
volume less than 400 ml in 24 hrs
Anuria :no urine
formation
Polyuria :urine more
than 3 litres per day.(normal 1.5 liters per day)
What are 2 important feature of AGN?
1.Hypertension
2.RBC casts
RBC casts are
diagnostic of AGN
Hypertension occurs in
AGN but not in nephritic syndrome.
How do you investigate?
Urine microscopy: RBC
casts
Throat swab and culture
Skin lesion culture
ASO titer
Urine protein
(increase)
Urea, creatinine may be
abnormal
Renal biopsy shows
feature of Glomerulo nephritis.
How do you treat?
Salt restriction
Diuretics
Antibiotics-if there is
evidence of underlying strepto infection
Normal protein
excretion is less than 150 mg /24 hrs
What is IGA nephropathy?It is
Focal proliferative
glomerulo nephritis
There is mesangeal proliferation
ofIGA
SimulatesGN in
henoch-schonllein purpura
Occurs in children and
young males
2 commonManifestation1.
gross hematuia or2. microscopic hematurea
Usually associated with
upper respiratory infection or gastroenteritis
Abnormal proteinuria
present(5% nephrotic)
Can also present with
acute kidney injury or chronic kidney disease.
Rapidly Progressive glomerulo nephritis(RPGN)
Proliferative Glomerulo
nephritis with crescent formation
Crescent is aggregation
ofmacrophages and epithelial cells in Bowmens capsule
Severe damage to
glomerular tuft is present
Especially occurs in
Goodpasture’s syndrome,Wegners granulomatosis.
What is Good pasture’s Sydrome?
This is a rare auto
immune disorder.
Glomerulo nephritis
associated with hemoptysis
Anti GBM antibodies are
produced against glomerular basement membrane
GBM has antigenic
similarity to lung alveolar membrane
Hence both GN and lung hemorrhage occurs in this syndrome.
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