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Acute

Glomerulonephriti
s
GROUP 3

Synopsis

one of the most common glomerular causes of gross hematuria


in children

major cause of morbidity caused by group A-hemolytic


streptococcal infections

many as 50% of cases may be subclinical

predominance is noted in symptomatic cases

hygienic conditions and the near eradication of streptococcal


pyoderma

most common in children

Epidemiology

majority of cases are sporadic

97% of cases occur in less- developed countries

overall incidence has decreased in industrialized nations due to


improved

ages 5-12 years peak

prevalence in approximately 5-6 years

uncommon before the age of 3 years

male

Etiology

follows infection by certain nephritogenic strains of GAHS

Follows pharyngitis during cold months or skin infections or


pyoderma during warm months

epidemics and clusters of household cases occur throat


infections (serotypes M1, M4, M25, and some strains of M12) skin
infections (serotype M49)

General Symptoms

Fever

Headache
Malaise
Anorexia
Nausea and vomiting
High blood pressure
Pallor due to edema and/ anemia
Confusion
Lethargy
Loss of muscle tissue

Enlargement of the liver

Signs and Symptoms

Hematuria: dark brown or smoky urine

Oliguria: urine output is < 400 ml/day

Edema: starts in the eye lids and face then the lower and
upper limbs then becomes generalized; may be migratory

Hypertension: usually mild to moderate

Clinical syndromes

urinary (haematuria, proteinuria),

nephritic (edemas, hypertension, gross haematuria, proteinuria),

nephrotic (edemas, proteinuria, hypoproteinemia, hypercholesterolemia),

mixed.

CLINICAL FEATURES
Abrupt

onset of:

glomerular haematuria (RBC casts or


dysmorphic RBC).

non-nephrotic range proteinuria (<2 g


in 24 hrs).

edema (periorbital, sacral).

hypertension.

transient renal impairment (oliguria,


uraemia).

DIAGNOSIS
Base line measurements:
- Urea
- Creatinine
- Urinalysis (MSU):
a) Urine microscopy (red cell cast)
b) proteinuria

OTHER :

Electrolyte

Complete blood count (CBC)

Urine culture

Lupus serologies

Measurement of complement components (ie, C3, C4)

Antistreptolysin-O (ASO) titer

Anti-DNAase B

Perinuclear antineutrophil cytoplasmic antibody

(P-ANCA) measurement

Cellular antineutrophil cytoplasmic antibody

(C-ANCA) assessment

Serum IgA measurement

Differential
Diagnosis of
AGN
I.

LUPUS NEPHRITIS

II.

IGA NEPHROPATHY

III.

MEMBRANOPROLIFERATIVE GN (MPGN)

IV.

GN OF CHRONIC INFECTION

Lupus Nephritis

Common and serious complication of systemic SLE

Results from the deposition of circulating immune complex, which


activate the complement cascade leading to complement-mediated
damage, leukocyte infiltration, activation of procoagulant factor,
which release of various cytokines

Symptoms of Lupus Nephritis

For many, the first noticeable symptom is swelling of the


legs,ankles and feet. Less often, there can be swelling in the face or
hands.

Other symptoms can vary from person to person and from day to
day. They may include:

Weightgain

High blood pressure

Dark urine

Foamy, frothy urine

The need to urinate during the night

Lupus Nephritis

Physical Examination

With focal and diffuse lupus nephritis, the physical


examination may reveal evidence of generalized active
SLE with the presence of a rash, oral or nasal ulcers,
synovitis, or serositis. Signs of active nephritis are also
common.

With active lupus nephritis, patients have


hypertension, peripheral edema, and, occasionally,
cardiac decompensation.

With membranous lupus nephritis, signs of an isolated


nephrotic syndrome are common. These include
peripheral edema, ascites, and pleural and pericardial
effusions without hypertension.

IgA Nephropathy

also known as Berger's disease

is a kidney disease that occurs when an antibody called


immunoglobulin A (IgA) lodges in your kidneys. This results
in local inflammation that, over time, may hamper your
kidneys' ability to filter wastes from your blood.

Signs and symptoms of IgA nephropathy when


kidney function is impaired include:

Cola- or tea-colored urine (caused by red blood cells in the urine)

Repeated episodes of cola- or tea-colored urine, sometimes even


visible blood in your urine, usually during or after an upper
respiratory or other type of infection

Pain in the side(s) of your back below your ribs (flank)

Swelling (edema) in your hands and feet

High blood pressure

IgA Nephropathy

Physical examination findings in patients with IgA nephropathy


are usually unremarkable. A minority of patients have
hypertension. More commonly, however, hypertension manifests
as the course of the disease lengthens or when patients develop
chronic kidney disease and end-stage renal disease (ESRD).

Membranoproliferative GN (MPGN)

MPGN occurs when your immune system malfunctions,


mistakenly attacking healthy cells. Underlying conditions
that contribute to abnormal immune system function
include:

autoimmune diseases, such as scleroderma, lupus,


Sjogrens syndrome, and sarcoidosis

certain cancers, such as leukemia and lymphoma

certain types of infections, such as hepatitis B, hepatitis


C, malaria, and endocarditis

Sometimes its not possible to identify the cause of the


disease. MPGN typically develops in children between the
ages of 8 and 16 who have one of these conditions.

Membranoproliferative GN (MPGN)

These signs and symptoms can include:

blood in your urine

changes in your mental status, such as confusion or lethargy

cloudy urine

dark urine

a decrease in urine volume

swelling, or edema, in your hands, feet, or face

GN of chronic infection

The history should begin by focusing on causespecific symptoms to determine the source of the
chronic kidney disease (CKD) if this is unknown.
Recognition of such symptoms facilitates the
planning of further workup and management of
the disease (if systemic).

The next step is to look for symptoms related to


uremia to determine if renal replacement therapy
is needed.

GN of chronic infection

The following symptoms suggest uremia:

weakness and fatigue

loss of energy, appetite, and weight

pruritus

early morning nausea and vomiting

change in taste sensation

reversal in sleep pattern (ie, sleepiness in daytime and


wakefulness at night)

peripheral neuropathy

seizures

tremors

GN of chronic infection
Physical

examination

Hypertension

Jugular venous distension

if severe volume overload is present

Pulmonary rales

if pulmonary edema is present

Pericardial friction rub in pericarditis

Tenderness in the epigastric region or blood in the stool

possible indicators of uremic gastritis or enteropathy

Decreased sensation and asterixis

indicators of advanced uremia

TREATMENT:

Mainly supportive

If associated with chronic infections, treat the underlying cause.

Diet and activity

Bed rest

PHARMACOLOGIC TREATMENT:

Penicillin

Loop diuretics

Vasodilator drugs (Nifedipine, Nitroprusside. Hydralazine)

Thank

You!