Acute glomerulonephritis: (Acute nephritic syndrome)

Extract

[...] Renal Biopsy:- (Indications) GN with Systemic features Absence of serological evidence of streptococcal infection Biopsy Indications Normal C3 level in acute phase Mixed picture of AGN & NS ARF requiring dialysis Delayed resolution Natural history of post strep. GN Oligouria and hypertension persists for 2 weeks Gross hematuria may persist for 3-4 weeks Low C3 levels for 6-8 weeks Microscopic hematuria may persist for upto 1 year Treatment No specific therapy-Symptomatic Mild cases-Managed in OPD Hospital Care: High BP, Oliguria, Anasarca, ↑↑Creatinine, - AGN with complications Hospital Treatment Bed rest:- until diuresis starts and ESR returns to normal Diet: salt and protein restricted. [...]

[...] Others –rare in children: - DM - Amyloidosis - Acute interstitial Nephritis Poststreptococcal AGN Infection of throat or impetigo by Grp A ß- hemolytic streptococcus of nephrogenic strains Ab formation against Ag Protein, Streptoccocal Protease) Deposition of immune complexes in Glomerular cap Inflammatory response Activation of Classic & Alternate pathways Glomerular injury Clinical Features Age 5-15 yrs, rare below 3 yrs Sex-M> F H/O sore throat 7-10 days prior H/O pyoderma 2-4 weeks prior Epidemics of S. throat infection-Subclinical cases only with microscpic hematuria Most common presentation Gross Hematuria mild facial edema (starts from around the eyes) Urine –typically reddish brown/smoky or cola colored, scanty urine Headache due to hypertension(Vol overload) Non specific symptoms- malaise, lethargy abd or flank pain ,fever Heat coagulation test: Atypical Presentations CCF & Acute Pul Edema- Dyspnea, restlessness, may be hypotensive due to heart failure & shock Hypertensive encephalopathy-drowsiness, convulsion, blurring of vision, headache Acute renal failure Nephrotic Syndrome-Mixed picture of NS+ AGN Lab Investigations 1.Urine : RBC, RBC casts, granular casts and increased specific gravity,proteinuria C/S : 2.Complete blood count 3.Renal Function tests: S.electrolytes Blood urea S.creatinine STP and A:G 4. [...]