Poststreptoccal glomerulonephritis /certified fixed orthodontic courses by Indian dental academy


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Poststreptoccal glomerulonephritis /certified fixed orthodontic courses by Indian dental academy

  1. 1. Poststreptococcal Glomerulonephritis INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. Poststreptococcal GN (Introduction)    Usually occurs 10 days after pharyngitis and 14 days after skin infection (not synpharyngitic) Fallen incidence in US, but common in some rural areas, poor hygiene places, and tropical countries Occurs more often in males and children
  3. 3. Poststreptoccal GN (nephritic strains)    Known nephritic strains include M types 1, 2, 4, 12, 18, 25, 49, 55, 57, 60 Many proposed mechanisms: Molecular mimickry vs. autoimmune vs. polyclonal activation of B lymphocytes Repeat infections are not common as immunity is type specific and not usually transient
  4. 4. Clinical Presentation    Most patients have milder disease Classically, presents with overt nephritic syndrome and oliguric ARF Symptoms can include gross hematuria (100% microscopic), HA, htn (60-80%), hypervolemia, and edema (80-90%)
  5. 5. Clinical Presentation   Nephritic urinary sediment – dysmorphic RBCs, red cell casts, leukocytes, subnephrotic proteinuria Nephrotic-range proteinuria not common
  6. 6. Labs       Serum Cr can be commonly elevated at presentation, though mild C3 and CH50 decreased w/in 2 weeks C4 usually normal (complement level usually normal within 68 weeks) Most patients have directed Ab, such as ASO, anti-DNAse B, etc Serum IgG and IgM increased in 80% and returns to normal in 1-2 months Polyclonal cryoglobulinemia in 75%
  7. 7. Light Microscopy On light microscopy, usually see diffuse proliferative GN
  8. 8. Immunofluorescence Microscopy  Deposition of IgG and C3 3 patterns mesangial Starry sky (mesangial and capillary wall) Garland (capillary loops)
  9. 9. Electron Microscopy  large electron – dense immune deposits in subendothelial, subepithelial, and mesangial areas
  10. 10. Course      Irreversible Renal Failure rare – less than 1 % in children, slightly higher in adults Resolution usually quick, plasma Cr usually returns to previous levels by 3-4 weeks Hematuria resolves usually within 3-6 months, proteinuria falls at a slower rate Some patients experience htn, recurrent proteinuria, and renal insufficiency 10-40 yrs after > 20% of adults may have some degree of persistent proteinuria and or compromise of GFR 1 year out
  11. 11. Treatment    Eliminate strep infxn with abx Supportive therapy Diuretics and antihypertensives to control bp and extracellular fluid volume
  12. 12. Acute GN and Pulmonary Hemorrhage    ANCA associated systemic vasculitis and antiGBM - common causes Also reported to occur in SLE, HSP, mixed Cryoglobulinemia Study of 88 patients with Pulmonary Hemorrhage and Nephritis: 48 ANCA, 6 Anti GBM, 7 both, 27 neither ANCA nor anti-GBM (latter group – not many causes could explain both findings)
  13. 13. The End