ACUTE GLOMERULO NEPHRITIS

         

                                  ACUTE GLOMERULO NEPHRITIS

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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