For mbbs undergraduates

1. ACUTE GLOMERULONEPHRITIS

2. • Abrupt onset of hematuria
• Oliguria
• Edema
• Hypertension

3. ETIOLOGY
• 1)post infectious
• Strep,staph.hep BnC
• 2)Systemic vasculitis
• HSP,Wegener granulamatosis
• 3)others
• SLE,IgA nephropathy

4. Poststreptococcal GN
• AGN following group A hemolytic streptococci
• Infection of throat or skin precedes the onset
of nephritis by 1-4 wks

5. PATHOLOGY
• Light microscopy-proliferation of mesangial
cells and neutrophil infiltration
• Immunofluorescence-granular deposits of IgG
n complement C3
• Electron microscopy-deposits on subepithelial
side of GBM

6. Clinical Features
• School age children,males
Cola coloured urine
Puffiness around the eyes n pedal
edema
Oliguria
HTN
Mild proteinuria

7. Lab findings
• Urine-1-2+protein with redcells n
granular casts
• Hemodilution may result in normocytic
anemia
• ESR raised
• Blood urea n creatinine are elevated
• Hyponatremia n hyperkalemia

8. • ASO titre is increased
• Anti DNaseB is elevated
• Level of C3 is low

9. MANAGEMENT
• Mild oliguria n normal BP –managed at home
• 1)diet
• Restriction of Na K n fluids until blood urea
reduce n urine output increases
• 2)diuretics
• Oral furosemide at adose of 1-3mg/kg
• Pulmonary edema –IV frusimide 2-4 mg/kg

10. • 3)Hypertension
• Mild –restriction of salt n water intake
• amlodipine,nifedipine or diuretics
• 4)LV failure
• HTN should be controlled n IV
frusemide given to induce diuresis

11. • 5)prolonged oliguria
• Dialysis is indicated in children with
severe renal failure n prolonged
oligoanuria,fluid overload n life
threatening electrolytedisturbances

12. CRESCENTIC GN
• Rapidly progressive GN(RPGN)-a/c nephritic
illness accompanied by rapid loss of renal
function over days to wks
• Histopathology-crescents
• Management-initial administration of IV n oral
corticosteroids n IV cyclophosphamide followed
by maintenance immunosuppression
• Plasmapheresis in pauci-immune crescentic GN n
Goodpasture syndrome

13. NEPHRITIS IN HSP
• Most common vasculitis in children
• Microscopic hematuria n mild proteinuria
• Serum IgA levels elevate
• patient recover without any treatment
• Long term observation is necessary

14. IgA NEPHROPATHY
• Deposition of IgA in the glomeruli
• Recurrent episodes of gross hematuria
following URI
• Patient with hematuria n mild proteinuria-ACE
inhibitors
• Nephrotic range proteinuria or deranged renal
function –corticosteroids n alkylating agents

15. LUPUS NEPHRITIS
• Variable presentations
• Asymptomatic proteinuria,hematuria ,a/c
nephritic syndrome n neephrotic syndrome
• Mesangial n capillary wall deposits of IgG n
C3 n usually C1q n IgA
• Corticosteroids ,cytotoxic agents,calcineurin
inhibitors n monoclonal antibodies n
prompt treatment of infections has
improved outcomes