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Post-streptococcal glomerulonephritis: Wikis

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Acute proliferative glomerulonephritis
Classification and external resources
ICD-9 580.0
DiseasesDB 29306
MedlinePlus 000503
eMedicine med/889

In nephrology, acute proliferative glomerulonephritis is a disorder of the glomeruli (glomerulonephritis), or small blood vessels in the kidneys. It is a common complication of infections, typically streptococcal pharyngitis, for which it is also known as postinfectious or poststreptococcal glomerulnephritis.

It can be a risk factor for future albuminuria.[1]

Contents

Causes

Acute proliferative glomerulonephritis can be a complication of streptococcal pharyngitis (strep throat) and impetigo.

Pathophysiology

The exact pathology remains unclear, but it is believed to be type III hypersensitivity reaction. Immune complexes (antigen-antibody complexes formed during an infection) become lodged in the glomerular basement membrane. Complement activation leads to destruction of the basement membrane. It has also been proposed that specific antigens from certain nephrotoxic streptococcal infections have a high affinity for basement membrane proteins, giving rise to particularly severe, long lasting antibody response.

Diagnosis

Diagnosis rarely requires a renal biopsy since there is usually a classical clinical presentation. There will be elevated levels of ASOT Ab and low complement levels in the blood.

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Presentation

1) Hematuria:[2]

  • May be microscopic and not identified by the patient.
  • May be macroscopic and lead to dark brown or smoky urine.
  • Frank hematuria may occur in severe case.

2) Oliguria

  • Urine output is less than 400 ml/day (normally 600 to 2500 ml/day).in children less than .5ml/hour/day
  • May be not observed by the patient.

3) Edema

  • Acute onset.
  • Mild to modest severity.
  • Pitting edema.
  • It may be migratory: appear in eyelid in the morning, disappear in the afternoon and reappear around the ankle in the ambulant patients by the end of the day.

4) Hypertension.

  • It is usually mild to moderate.
  • Pulmonary congestion and congested neck veins may be present, but usually due to salt and water retention and less commonly heart failure.

5) General

  • Fever, headache, malaise, anorexia, nausea and vomiting.
  • Pallor due to edema and/or anemia.

6) Acute renal necrosis due to injury of capillary or capillary thrombosis.

  • Acute tubular obstruction by cast.

Mechanism of edema

A) Decreased glomerular permeability

B) Secondary hyperaldosteronism

C) Hypoalbuminemia

Differential diagnosis

  1. Other causes of acute glomerulonephritis:
  2. Nephrotic syndrome
  3. Other causes of generalized edema:
    • Malnutrition
    • Malabsorption
    • Renal affection
    • Liver cell failure
    • Right side heart failure
    • Angioedema
  4. Other causes of hematuria

complication

-renal faliure -hypertensive encephalopathy

References

External links


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