Acute glomerulonephritis_

$ DEF_ It is characterised by hematuria, oliguria, edema & hypertension, in severe

cases anuria,hypertensive encephalopathy & heart failure.
$ CONDITIONS PRESENTING AS AGN-
1. Post infectious_ streptococci, hepatitis b&c, bact endocarditis
2. Systemic vasculitis_ Henoch- schonlein purpura, SLE, PAN.
3. Membranoproliferative GN_
Ig A nephropathy, familial nephropathy- Alport syndrome.
$ POST-STREPTOCOCCAL GN_
~Acute GN following inf by streptococi. Involves school age.below 3 yrs age group.
~ streptococcal inf of throat & skin & preceds onset of nephritis by 1-4 wks
~ immune complex disease
~streptococcal Ag-Ab complexes trapped in glomerular capillaries where activate
complement & initiate inflanatory changes.
$ PATHOLOGY_
Glomeruli enlarged & ischaemic & capillary loops narrowed + proliferation of
mesamgial cells & infiltration with neutrophills.
$ C/F_
~rapid onset, pedal edema with puffiness around eyes.
~ urine-> cola colored
~ hypertension
~convulsions due to hypertensive encephalopathy.
~L.V.F. & pulm edema due to malignant hypertension & hypervolemia
~ acute renal failure
$LAB FINDING_
~URINE_ 1 + to 2 + protein with red cells & granular cast, white cells.
~hemodilution_anemia
~esr_ increased.
~blood levels urea, creatinine_ increased causing renal impairenent.
~chest x ray_ prominent vascular markings showing hypervolemia.
~throat swab culture_ beta hemolytic strepto.
~ASO titre_ increased > 80 % patients
~serum c3 low
$ TREATMENT_
mild grade manage at home.
principles _
1. Diet_intake of protein, sodium, potassium restricted to an amt equal to
insensible losses. Overhydration is complicatn.
2. Wt._weighed daily. Reduction in fluid intake.
3. Diuretics_ not indicated unless pulm edema. Furosemide i.v. 2-4 mg/kg.
4. Hypertension_ mild treated by salt & water intake. Malignant hypertension
treated by i.v. Nitroprusside.
5. LVF_hypertension should be controlled & i.v. frusemide administered.significant
diuresis may occur leading to improvement in heart failure. If immediate diuresis
is not seen,steps are taken to initiate dialysis. Venesection with removal of 100-
200 ml of blood or tying rotating torniquets, to reduce venous return.
6. Prolonged oliguria_
above treat continued.
Dialysis require for children wit severe renal failure & prolonged oligoanuria,
fluid overload.
$ OUTCOME & PROGNOSIS_ Acut GN good prognosis in childhød. symptoms disappear in
1 st week_ loss of edema & fall in b.p.
2nd wk._hematuria, proteinuria.
2-3 wk_ hypertension
close folloup with urinalyses, b.p. Measure.
$ RENAL BIOPS- when renal funct severly impaired beyond 10-14 days.