Acute glomerulonephritis (AGN) is an inflammatory process affecting the glomerulus caused by post-infectious processes or immune-complex deposition. It is characterized by hematuria, edema, and hypertension. AGN most commonly affects children ages 5-12 and is often caused by streptococcal infections. The infection triggers an immune response forming antigen-antibody complexes that lodge in the glomerulus and cause inflammation, reducing glomerular filtration rate and leading to renal insufficiency, edema, and oliguria. Treatment focuses on diuretics to reduce edema, antihypertensives to control blood pressure, and dialysis in severe cases.

1. ACUTE
GLOMERULONEPHRITIS

2. AGN-Definitions
• Inflammatory process affecting primarly the
glomerulus, with infiltration and proliferation
of acute inflammatory cells,which is
characterized by sudden onset of hematuria
olig.uria, edema and hypertension.

3. Incidence
• APSGN is the commonest glomerulonephritis
affecting children.(nephrogenic strains of
Group A streptococcus)
• Common among 5-12 yrs of age.
• 2-4 % of pediatric admissions.

4. Etiology
• Post infection:Streptococci,staphylococci,
pneumococci,meningococci,salmonella and treponema
hep B nd C,EBV,coxasackie virus,infection of shunts
and infective endocarditis.
• Systemic vasculitis: microscopic poly arthritis.
• Others:SLE,IgA nephropathy,membreno proliferative
glomerulonephritis.

5. Pathophysiology
• Streptococcal infection produces an immune
response by forming antibodies which
combine with antigens to produce antigen-
antibody complex.
• When these complexes pass through the
circulation get trapped in the glomerulus and
activate an inflammatory response in the
glomerular basement membrane.

6. Contd….
• The products of the inflammatory response
damage the glomerular capillaries and and
reduce the size of the capillary lumen.
• Decreased glomerular filtration rate
• Renal insufficiency
• Edema,oliguria due to fluid retension
• Injury to capillary walls-RBC,cast and protein
pass through the urine

7. Clinical features
• Edema: puffiness of face,peri orbital and pedal
edeme
• Mild proteinuria
• Hematuria
• Oliguria
• Hypertension
• Fever malaise and loin pain
• History of sore throat or pyoderma 1-3 weeks
before

8. • Atypical presentation of AGN are
convulsions,left ventricular failure,pulmonary
edema,acute kidney injury and nephrotic
syndrome

9. Phases
• Latent phase
• Acute phase
• Recovery phase
Triad of symptoms of PSAGN
Edema
Hematuria
Hypertension

10. Diagnosis
• Urine:RBC,casts,neutrophils and albumin1 -2+
• Blood: raised urine creatine,low sodium,high
potassium, raised ASO titre.
• Renal biopsy in severe cases

11. Treatment
• Diuretics: edema-Frusemide1-3mg/kg
• Hypertension: Fluid and salt restriction,
antihypertensives-amlodipine,nifedipine or
diuretics.
• Oliguria: blood urea and electrolytes are
monitored .Dialysis in severe cases.

12. Contd….
• Left ventricular failure: IV frusemide,dialysis
and respiratory support.
• Diet: sodium, potassium and fluid are
restricted until blood uea decreases and urine
out put increases.

13. Nursing management
• Interventions include
Maintaining fluid volume
Promoting rest and activity
Maintaining skin integrity
Maintaining nutrition
Reducing anxiety