Topic: Nephritic syndrome, Acute glomerulonephritis Faculty: Pathology Course: ATOT 2nd year - Nephritic syndrome - Acute post-streptococcal glomerulonephritis(PSGN): definition, causes, pathogenesis Reference: Ramadas Nayak - Textbook of Pathology for Allied Health Sciences

1. ACUTE
GLOMERULONEPHRITIS
Dr. Salman Ansari(MBBS)
Tutor, Dept. of Pathology
Kanachur Institute of Medical Sciences

2. ● Nephritic syndrome
● Acute glomerulonephritis(PSGN)
● Definition
● Causes
● Pathogenesis
● Clinical features, Diagnosis and treatment

3. Nephritic syndrome
● Clinical syndrome presenting as:
● Hematuria and RBC casts,
● hypertension,
● oliguria,
● edema
● Less prominent: proteinuria(<3.5 g/day)
● Acute proliferative glomerulonephritis is one of the main causes
of nephritic syndrome

4. Etiology:
- post-streptococcal glomerulonephritis(PSGN) in children
- Rapidly progressive glomerulonephritis(RPGN)

5. Pathogenesis: neutrophils cause disruption of glomerular
basement membrane
Pathology:
Microscopy shows diffusely enlarged glomerulus with leukocyte
infiltration

7. Clinical features
- Periorbital and pedal edema
- cola-coloured urine(hematuria)
- Hypertension
- Oliguria
- Non-nephrotic proteinuria(less 3.5 g/day)
Treatment: Supportive treatment - antihypertensives, diuretics,
corticosteroids

8. Acute proliferative glomerulonephritis
● Group of glomerular diseases characterised by diffuse
proliferation of cells in glomeruli
● Immune complex-mediated
● Two types
1. Poststreptococcal
2. non-poststreptococcal

9. Poststreptococcal GN(PSGN)
● Occurs following streptococcus infection of throat(pharyngitis)
or skin(impetigo)
● Common in developing countries

10. Etiology
- Causative organism: group A streptococcus(GAS)
- Occurs few weeks after streptococcus pharyngitis
- Immune complex-mediated - type III hypersensitivity reaction

11. Pathogenesis
Antibodies produced in response to streptococci
↓
Combine with antigen and form antigen-antibody complex
↓
Circulate in blood and get deposited within glomeruli of kidney
↓
Cause inflammation - “glomerulonephritis”

12. Morphology
Microscopy:
Hypercellular enlarged glomeruli with leukocyte infiltration

15. Clinical features
● Children between 6-10 years of age
● Malaise, fever, nausea
● Classic triad
1. hematuria(smoky or cola-coloured urine)
2. Periorbital edema
3. hypertension

18. PSGN
Hematuria
Edema Hypertension

19. Diagnosis
● Low serum complement(C3) level
● High anti-streptolysin-O(ASO) titer
● Urine analysis: hematuria, RBC casts
● RFT: high BUN, serum creatinine

20. Treatment
● Supportive
● Manage hypertension and oedema
● Restrict salt and fluid intake
● Diuretics, anti-hypertensive medications
Prognosis: good

23. References:
● Ramadas Nayak - Textbook of Pathology for Allied
Health Sciences
● StatPearls - Poststreptococcal Glomerulonephritis
Questions:
salman.s.ansari92@gmail.com
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