Post Infectious Glomerulonephritis (PIGN) is an immune-mediated glomerulonephritis typically caused by a non-renal infection. The most common cause is Post-Streptococcal Glomerulonephritis (PSGN) following a streptococcal throat or skin infection. PIGN is characterized by the deposition of immune complexes in the glomerular basement membrane. Clinical presentation includes hematuria, proteinuria, edema, and hypertension. Treatment involves supporting the patient and treating any underlying infection. Most patients fully recover, though some may develop long-term complications like chronic kidney disease.
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Brief explanation of each *refer harrison textbook for details causes of TIN
Acute interstitial nephritis
Chronic interstitial nephritis
Reflux nephropathy
Papillary necrosis
Sickle-cell nephropathy
Update on Patterns of Study in ANCA Associated Vasculitis presented at regional Northern Ireland Nephrology Meeting with Dr David Jayne as guest speaker..
HELLO FRIENDS HERE CAUSES OF HEMATURIA IS HERE MANAGEMENT IN NEXT PRESENTATION ...YOU CAN SEE AND SUBSCRIBE OVER YOU TUBE ...LEARN UROLOGY IS CHANNEL NAME
FOLLOW THE YOU TUBE CHANNEL FOR FUTURE UROLOGY VIDEO
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lupus nephritis is a autoimmune disease, commonly seen in adult and child and the medical or nursing care is also very important for this type of disease condition.
This was a review of different guidelines on lupus nephritis from ACR, EULAR, and KDIGO. Goal is appreciate similarities and differences between the different guidelines.
Brief explanation of each *refer harrison textbook for details causes of TIN
Acute interstitial nephritis
Chronic interstitial nephritis
Reflux nephropathy
Papillary necrosis
Sickle-cell nephropathy
Update on Patterns of Study in ANCA Associated Vasculitis presented at regional Northern Ireland Nephrology Meeting with Dr David Jayne as guest speaker..
HELLO FRIENDS HERE CAUSES OF HEMATURIA IS HERE MANAGEMENT IN NEXT PRESENTATION ...YOU CAN SEE AND SUBSCRIBE OVER YOU TUBE ...LEARN UROLOGY IS CHANNEL NAME
FOLLOW THE YOU TUBE CHANNEL FOR FUTURE UROLOGY VIDEO
https://www.youtube.com/channel/UCINcUe475Y3c3BvXHvZ8wEw
lupus nephritis is a autoimmune disease, commonly seen in adult and child and the medical or nursing care is also very important for this type of disease condition.
This was a review of different guidelines on lupus nephritis from ACR, EULAR, and KDIGO. Goal is appreciate similarities and differences between the different guidelines.
An update of this lecture is available at: https://www.slideshare.net/MohammedGawad/membranous-nephropathy-234601451
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A brief description of facial trauma , reading facial xrays and management of facial trauma for interns and junior mo's covering casualty in a rural/semi-rural setting
Steroid resistant nephrotic syndrome in children: Clinical presentation, rena...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Presented by Jane Dematte, MD at the Scleroderma Patient Education Conference hosted by the Scleroderma Foundation on Saturday, October 12, 2019 in Chicago, IL
Encapsulate peritoneal dialysis after short term peritoneal dialysisNakisa Hooman
Encapsulated Peritoneal Sclerosis (EPS) is a devastating complication of long term CAPD. The diagnosis is based on structural and functional aspects of intestinal obstruction. The total imaging score at the time of diagnosis of EPS did not correlate with the clinical outcome. It is important to differentiate simple peritoneal sclerosis from EPS.The incidence increases from zero to 18% with time on peritoneal dialysis for 5-8 years. The risk of EPS increases exponentially when PD continues beyond 3 years. The other potential risk factors are high strength glucose exposure, icodextrin, young age, inflammation, chemical exposure, genetic factors, acidic PD fluid. Peritoneal injury and subsequent peritoneal inflammation are two hit hypothesis for EPS. But episodes of peritonitis, intense or repeated hemoperitoneaum, abdominal surgery, stopped PD, and genetic predisposition could be the potential risk factors. There is no authentic screening tool for early diagnosis. The combination of Ca-125<33 U/min and IL-6>350 pg/min with UFF suggest the possibility to identify patients at risk. High levels of cytokines in peritoneal effluent correlate with alteration peritoneal membrane transport status. The pathophysiology of EPS consists of inflammation, fibrin deposition and fibrinolysis, epithelial-mesenchymal transition, and growth factors. Ultrafiltration failure and high average transport status are very common in EPS. High awareness to detect the earliest stage of EPS might help to improve survival. Discontinuation of PD, nutritional support, immunosuppressive therapy, tamoxifen and surgery are medical options. There is no strategy to prevent EPS. In the case of PD catheter removal, dry peritoneum might lead to new fibrin deposition and accelerate sclerosing process. Periodic irrigation of peritoneal cavity for 6-12 months after cessation of PD therapy might prevent intestinal adhesion.
Serum interleukin - 6 level among sudanese patients with chronic kidney disease
Authors:Safaa I.A Nasr , Rbab A.M Adam , Hala M.M Ibrahim , Afra S.A Abdelgadir , Ibrahim Alkider , Solomon M. Gamde , Simon P. Abriba
Int J Biol Med Res. 2023; 14(4): 7652-7654 | Abstract | PDF File
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Background
• PIGN is an immune mediated glomerulonephritis.
– Cause by many type of non renal infection.
– Most common is PSGN.
• PSGN 28-47% (decline from the past).
• Staphylococcus12-24%
• Gram negative bacteria 22%
Chapter 9; Infection-related GN. Kidney International Supplements (2012) 2, 200–208; doi:10.1038/kisup.2012.22
3. Burden of disease
• Overall, rates are higher in children than adults.
– PSGN primarily affected children (2-12 yrs)
• Only 10% in adult (>40 yrs)
• Currently, no large scale published study of infection
associated GN other than streptococcus.
4. Epidemiology
• Global estimated of PSGN is around 472,000/yrs
– 96.6% from less developed countries.
– Represent only the clinical case, asymptomatic case is
predicted to be 4-19 times greater.
• Incidence decline in the past decade due to
– Better health care, wide spread of ABO used.
Jackson, S.J., et.al, Systematic Review: Estimation of global burden of non-suppurative
sequelae of URI: rheumatic fever and PSGN. Trop Med Int Health, 2011. 16(1): p. 2-11.
6. Samih H. Nasr, et.al, Bacterial infection-related GN in adults. Kidney international, 2013. 83: p. 792-803.
7. Pathogenesis
• Pathognomonic is the deposition of immune complex
in GBM, especially in PSGN (GAS).
– Nephritogenic antigens lead to the activation of
complement pathway.
• Many of Nephritogenic GAS strain, especially Streptococcal factor (M
Protein); type 1,2,3,4,12,25,49 (Skin) or 2,47,49,55,57,60 (throat).
• Nephritis associated plasmin receptor (NAPlr), co-localized with C3.
– Increase permeability of GBM.
– Deposition of immune complexs.
• C3 pathway tissue destruction, IgG deposition.
Nordstrand, A., et.al, Pathogenic Mechanism of APSGN. Scandinavian J Infect Dis, 1999. 31(6): p. 523-537.
8. Rodriguez-Iturbe, B. and J.M. Musser, The current state of PSGN. J Am Soc Nephrol, 2008. 19(10): p. 1855-64.
9. Samih H. Nasr, et.al, Bacterial infection-related GN in adults. Kidney international, 2013. 83: p. 792-803.
10. Pathological appearance
• Base on the glomerular change…
– Proliferation of mesangial, endothelial and epithelial cells,
inflammatory exudate and early deposition of C3 then IgG.
• Immune deposition classified into 3 patterns.
– Starry Sky pattern.
– Garland pattern.
– Mesangial pattern.
Sorger, K., et al., Subtypes of APIGN. Synopsis of clinical and pathological features. Clin Nephrol, 1982. 17(3): p. 114-28.
11. M Nagata. PIGN and variants. Division of kidney and vascular pathology, graduate school of human sciences, University of Tsukuba, Japan.
12. M Nagata. PIGN and variants. Division of kidney and vascular pathology, graduate school of human sciences, University of Tsukuba, Japan.
13. M Nagata. PIGN and variants. Division of kidney and vascular pathology, graduate school of human sciences, University of Tsukuba, Japan.
14. M Nagata. PIGN and variants. Division of kidney and vascular pathology, graduate school of human sciences, University of Tsukuba, Japan.
15. Clinical presentation
• Abrupt onset of Acute nephritis(1)
– 1-3 wks after streptococcal throat infection
– 3-6 wks after skin infection
• Typical Presentation(2)
– Hematuria, gross or microscopic (100%)
– Low complement (C3) (90%)
– Edema (75-90%)
– Proteinuria (80-92%)
– Hypertension (60-80%)
– Oliguria (10-58%)
– Other such as facial puffiness, malaise, weakness or anorexia.
(1) Nordstrand, A., et.al, Pathogenic Mechanism of APSGN. Scandinavian J Infect Dis, 1999. 31(6): p. 523-537.
(2) Sotsiou F. Postinfectious glomerulonephritis. Nephrol Dial Transplant 2001;16 Suppl 6:68-70.
16. Samih H. Nasr, et.al, Bacterial infection-related GN in adults. Kidney international, 2013. 83: p. 792-803.
17. Basic investigation
• Urinalysis reveal hematuria in all patients.
– Proteiuria may be subnephrotic or nephrotic range.
• Serum creatinine may elevated.
• Renal ultrasound may not required.
– Imaging is usually use for screening structural abnormalities.
18. Specific Investigation
• Antibody to streptococcus.
– Antistreptolysin O titer (ASO) following throat infections.
(90% sensitivity)
– Anti-DNAse B titers following skin infections.
(80% sensitivity)
– Other such as Anti-hyaluronidase (AHase),
Anti-streptokinase (ASKase), Anti-nicotinamide-
adenine-dinucleotidase (Anti-NAD)
• Culture evidence of streptococcus (10-70%).
• Complement level.
– Decrease of C3 and CH50.
– Normal or slightly low of C4.
Blyth CC, et.al. PSGN in Sydney: a 16-year retrospective review. J Paediatr Child Health 2007;43:446-50.
19. Management
• Mainstay of treatment is supportive.
– Close monitoring BP, renal function and clinical.
– Volume overload Diuresis and restrict sodium.
– Antihypertensive as need.
• Treat underlying infection.
– Penicillin for persist streptococcal infection.
• Erythromycin if patient is allergic to Penicillin.
G Singh. PIGN. An update on Glomerulopathies – Clinical and treatment aspect ,2011:113-124.
20. Management
• Complete recovery is 90% of children and 60% of adult.
– The rest developed hypertension or renal failure.
• Recheck serum complement at 6-8 wks.
• Annually check BP, renal function test and urinalysis
every 1-3 month for 1 yr then yearly.
• Kidney biopsy not indicated in all patient.
G Singh. PIGN. An update on Glomerulopathies – Clinical and treatment aspect ,2011:113-124.
21. Management
• Pulse of IV Methylprednisolone may consider in
extensive glomerular crescent/ RPGN.
– Currently no evidence from RCT.
• Adult patient who have persistent proteinuria >1gm/
day should receive ACE-I or ARBs.
Chapter 9; Infection-related GN. Kidney International Supplements (2012) 2, 200–208; doi:10.1038/kisup.2012.22
22. Recovery phase
• Mostly urinary abnormalities clear within 12 wks.
– Proteinuria may persist from 6 months – 3 yrs.
– Hematuria may persists from 1-4 yrs.
• C3 level usually normalize within 8-12 wks.
Yoshizawa, N., Acute glomerulonephritis. Intern Med, 2000. 39(9): p. 687-94.
23. Kidney Biopsy
• Indicated in..
– Persistent of low C3 beyond 6-12 wks.
– Persistent or rapid declined of renal function.
– Persistent HTN or lack of renal improvement within 2 wks.
– Recurrent Hematuria.
– Cannot excluded other diagnosis…
• Absent history of latent period.
• Normal complement level.
• Negative anti streptococcal antibodies.
• Symptom and sign of other systemic disease such as Malar rash.
24. Prognosis
• Extremely variable may fully recovery or progressive.
– Children usually have excellent prognosis.
• Unfortunately, 25% of Adult will progress to CRF.
– Epidemic spreading may have better prognosis, except
S. Equi Zooepidermicus.(1)
– Lack of a clinical or biomarker for predict outcome.
• Neutrophil gelatinase-associated lipocalin (NGAL-AKI), not yet
evaluated in PIGN(2)
(1) Sesso, R. and S.W. Pinto, Five-year follow-up of patients with epidemic GN due
to Streptococcus zooepidemicus. Nephrol Dial Transplant, 2005. 20(9): p. 1808-12.
(2) Haase, M., et al., Accuracy of NGAL in diagnosis and prognosis in AKI: a systematic review
and meta-analysis. Am J Kidney Dis, 2009. 54(6): p. 1012-24.
25. Prognosis
• Poor prognosis indicated in…(1)
– History of childhood PSGN.(2)
– Older age.
– History of massive proteinuria.
– History of Alcoholism or drug abused.
– Underlying disease such as Diabetes, Cardiovascular and liver disease.
– Persistent abnormal renal function.
– History of dialysis at presentation.
• Biopsy feature(including crescent) or steroid treatment not
correlated with prognosis of Adult PIGN(3)
(1) Rodriguez-Iturbe, B. and J.M. Musser, The current state of PSGN. J Am Soc Nephrol, 2008. 19(10): p. 1855-64.
(2) White, A.V., et.al. Childhood PSGN as a risk factor for chronic renal disease in later life. Med J Aust, 2001. 174(10): 492-6.
(3) Nasr SH,et al. APIGN in the modern era: experience with 86 adults and review of the literature. Medicine (Baltimore) 2008; 87: 21–32.
26. Prevention
• Evidence base using Benzathine Penicillin G IM for halted
bacterial transmission in GAS skin infection.(1)
• In experimental, Nephritic process is prevented if penicillin is
given within 3 days of strep- infection.(2)
• Prevention of epidemic PSGN required community level
control of skin sores, infected scabies by regular washing.
• GAS vaccine currently under development.(3)
(1) Johnston, F., et al., Evaluating the use of penicillin to control outbreaks of APIGN. Pediatr Infect Dis J, 1999. 18(4): p. 327-32.
(2) Bergholm, A.M. and S.E. Holm, Effect of early penicillin treatment on the development of experimental PSGN. Acta Pathol
Microbiol Immunol Scand C, 1983. 91(4): p. 271-81.
(3) Georgousakis, M.M., et al., Moving forward: a mucosal vaccine against GAS. Expert Rev Vaccines, 2009. 8(6): p. 747-60.
27. Sample Variant of PIGN
• Staphylococcus associated GN.
– Associated with ventrilovascular shunt, IE .
– Some resemble IgA nephropathy.
• HBV associated GN.
• HIV associated GN such as HIVAN, Immunotactoid.
• Report case of other infection associated GN.
28. GN associated with IE
• Incidence range from 22-78%.
– Highest among IV drug abused.
• Most typical finding is focal and segmental
proliferative GN.
• Prognosis is good, despite ABO as IE (4-6 wks).
29. Shunt nephritis related GN
• Immune mediated complex GN.
– Complication of chronic infection via ventriculovascular
shunts, common in treatment of hydrocephalus.(1)
• In contrast to vascular shunt, VP shunt rarely developed GN.
• Typical type I MPGN (dense deposit mesangial and subendothelial).
• Typical organisms are Staphylococcus spp.
Iwata Y, Ohta S, Kawai K et al. Shunt nephritis with positive titers for
ANCA specific for proteinase 3. Am J Kidney Dis 2004; 43: e11–e16.
30. HCV infection related GN
• HCV frequently causes extrahepatic manifestation.
• Kidney involvement…
– Most common associated with type II cryoglobulinemia.(1)
• Type I MPGN (Cryoglobulin deposits).
• Best long term prognostic indicator is HCV with SVR.
– RNA clearance from serum at least 6 month.
• Paucity of controlled study in HCV associated GN.
– Rituximab plus Peg-interferon a2b and Ribavarin show good response
in stabilized kidney function in cryoglobulinemic vasculitis.(2)
(1) Chapter 9; Infection-related GN. Kidney International Supplements (2012) 2, 200–208; doi:10.1038/kisup.2012.22
(2) Saadoun D, Resche-Rigon M, Sene D et al. Rituximab combined with Peg-interferon-ribavirin in
refractory HCV -cryoglobulinaemia vasculitis. Ann Rheum Dis 2008; 67: 1431–1436.
31. HBV infection related GN
• Pattern of kidney involvement included.
– MN is the most common form, especially in children.
– Other such as MPGN, FSGS and IgAN.
• Exclude other cause of GN first.
• Prognosis…
– In children high spontaneous remission.
– In adult usually progressive, especially with abnormal LFT and
nephrotic syndrome, >50% progressing to ESRD.
• Treat HBV infection.
• Currently no data about efficacy of treatment in HBV- related GN.
Chapter 9; Infection-related GN. Kidney International Supplements (2012) 2, 200–208; doi:10.1038/kisup.2012.22
32. HIV related GN
• Variety spectrum of kidney disease.
• HIVAN is the most common cause of CKD in HIV-1.
– APOL1 gene related.
– Typical collapsing FSGS on pathology.
– HAART is beneficial in both preservation and improvement
in kidney function.
• Unfortunately, it may not effective in other GN associated with
HIV infection.
• ACE-I may benefit in HIV with nephrotic syndrome.
34. Schistosomal nephropathy
• S.Mansoni and S.japonicum, blood fluke.
– Incidence is not well defined.
• GN most commonly seen in young adult males.
• Commonly seen eosinophiluria (65%) and
hypergammaglobilinemia (30%).
• Aware co-infection with salmonella. Especially in Hepatosplenic
involvement.
• Once established GN, currently no effective therapy.
– None of immunosuppresant recommended.
• Prevent by Praziquantel or Oxamiquine.
35. Filarial nephropathy
• Loa loa, Onchocerca volvulus, W. bancrofti and B. Malayi.
– Immune mediated from worm antigens.
• Urinary abnormalities have been reported 11-25%.
• Nephrotic syndrome 3-5%, concomitant with polyarthritis and
chorioretinitis. Especially in lymphatic filariasis.
• Can induce diffuse GN and MPGN, MPGN, MND or Sclerosing GN.
• Treat by Ivermectin or Diethylcarbamazepine.
• Proteinuria can increase and kidney function may worsen
following initiation of therapy due to immune process.
Chapter 9; Infection-related GN. Kidney International Supplements (2012) 2, 200–208; doi:10.1038/kisup.2012.22
36. Malarial nephropathy
• P.Falciparum.
– May resulted in AKI or proliferative GN.
• P.Malariae.
– Variety of kidney disease especially MN or MPGN.
• Currently no RCT for evidence base treatment.
– Suggestion only appropriate anti-Malarial agent.
Chapter 9; Infection-related GN. Kidney International Supplements (2012) 2, 200–208; doi:10.1038/kisup.2012.22