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SYNDROME
(this is the edited slides, after discussions with Assoc. Prof. Dr. Rashid =)
and bedsite teaching with Dr Faisal =)
Introduction
• Synonyms: acute nephritis,
acute nephritic syndrome
• Clinical features:
– A sudden onset of hematuria,
– Proteinuria,
– Edema,
– Oliguria and volume overload,
– Hypertension,
– Azotemia is another common but inconstant finding.
Acute post
strep GN
IgA
Nephropathy
Membrano
Proliferative
Henoch
Acute Schonlein
Nephritic Purpura
Glomerulo syndrome
nephritis Alport
Nephrotic Syndrome
Syndrome
SLE
nephritis
Other post
infectious
glomerulo
nephritis
ACUTE
POST-STREPTOCOCCAL
GLOMERULONEPHRITIS
Outline
• Definition
• Epidemiology
• Etiology and Pathogenesis
• Clinical Features
• Complication
• Investigation
• Diagnosis
• Differential Diagnosis
• Treatment and Management
• Prognosis
Definition
AGN that follows an infection with a
nephritogenic strain of group A beta
hemolytic streptococci.
blood volume
edema
hypertension
Streptococcal pharyngitis Streptococcal impetigo
CLINICAL FEATURES
Typical Manifestation
Develop acute nephritic syndrome 1–2 wk after an
antecedent streptococcal pharyngitis or 3–6 wk
after a streptococcal pyoderma.
1. Edema
75% of the patients
Face, periorbital area lower extremities
generalized (ascites, pleural effusions) *c/o: dyspnea
o/percussion: stony dullness
o/auscultation: crepitations
2. Proteinuria – usu. normalize after 4 weeks
Not as severe as nephrotic syndrome (only <1g/m 2 /day. In nephrotic, >1g/m2 /day)
3. Oliguria
school child < 400ml/day
preschool child < 300ml/day Normal urine output of a
childL 1-2ml/kg/hour
infant & toddler < 200ml/day
Typical Manifestation (2)
3. Gross hematuria (65% of patients)
Don’t forget to
Smoky, tea-colored, cola-colored, or fresh
ask about the bloody urine
symptoms of
hypertension in
Microscopical hematuria (almost all
hx ok! Blurred patients)
vission? The urine appears normal, but >3 RBCs/HP
Headache?
Dizziness? are found in centrifuged urine sediment
examined microscopically.
5. Nonspecific symptoms:
Such as anorexia but with weight gain,
vomiting, general malaise, lethargy,
Meaning, renal function
restores after 5-10days
Clinical course
Spontaneous improvement typically begins
within 1 wk with resolution of edema in 5-10
days and hypertension in 2-3 wk, but
urinalysis may be abnormal (persistent
microscopic hematuria) for a year.
Complications in severe cases
• Circulatory hypervolemia / Congestive heart
failure Sx: Distended JVP,
dyspnea
• Activation of complements
– Serum C3 level, decrease (90%), return to normal within 6
weeks.
– Serum C4 levels are typically normal.
• Kidney ultrasound
– Not necessary if patient has clear cut acute nephritic
syndrome
Renal Biopsy
• Patients whose clinical presentation,
laboratory findings, or course is atypical.
• Delay resolution
o oliguria > 2 weeks
o Azotaemia > 3 weeks
o Gross haematuria > 3 weeks
o Persistent proteinuria > 6 months
1. Allergic
Apart from swelling + rashes, in history taking:
• Any shortness of breath?
• Any itchiness?
• Any history of allergy?
• Any family history of allergy?
2. Nephrotic syndrome (the ones with hematuria. Homework! =P)
3. Rheumatic fever?
• Meet the Jones criteria?
Treatment
• Treatment of APSGN is largely that of
supportive care.
• Usually, patients undergo a spontaneous
diuresis within 7 to 10 days after the onset
of their illness - strict monitoring –
nephrotic chart + fluid restriction until
diuresis
• Management is directed at treating the
acute effects of renal insufficiency and
hypertension
• Diuretics
Due to renal
insufficiency
• Diet
Fluid restriction– during oliguric phase
Sodium restriction is necessary
Protein restriction is unnecessary
• Antibiotics
Post strep GN is a A 10-day course of systemic antibiotic therapy with
sequelae after 2-
penicillin V is recommended to limit the spread of the
3weeks (not antigen-
mediated, but immune- nephritogenic organisms.
mediated). Hence the Antibiotic therapy does not affect the natural history of
need to administer
glomerulonephritis.
antibiotic, to get rid of
any strep left and
prevent further
immune-mediated cx Paediatric Protocols, 12th Edition
Treatment for complications
Recheck Oral Other
Bed BP ½ Add oral
nifedipine
rest hour Furosemide AHT
later
Fluid restriction
-withhold fluid for 24 Hrs if
possiible
Consider dialysis if no
response to diuretics