Acute Glomerulonephritis
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Introduction
- A disorder of structure and or a functional anomaly.
- Of an abrupt onset with a tendency to spontaneous recovery
- May be acute or chronic.
- Chronic type is a common cause of ESKD in children.
- Could be caused by post streptococcal glomerulonephritis, diffuse proliferative glomerulonephritis, mesangial proliferative glomerulonephritis, focal segmental glomerulosclerosis, membranous glomerulopathy, rapidly progressive glomerulonephritis, systemic illness, SLE, Henoch Schonlein Purpura, HBV, poly arteritis nodosa
- The commonest cause in this environment is post streptococcal
Clinical features
- History of passage of dark smoky urine, preceding sore throat, skin infection, facial or pedal oedema, seizure, oliguria, anorexia
- Physical examination - Hypertension, oedema, respiratory distress in presence of severe fluid accumulation, seizures, hypertensive encaphalopathy
Diagnostic Criteria
- Gross hematuria
- hypertension
- oliguria
are the hall mark of diagnosis
Complications
- Hypertensive encephalopathy
- acute kidney injury
- hyperkalemia
- fluid overload
- congestive cardiac failure
Investigation:
Urinalysis:
- pH-acid
- colour-dark smoky urine
- Red cell casts commonly may be absent and repeated urinalysis of fresh urine may be needed
leucocyte (pyuria)
- waxy – suggest pre existing nephritis
- pr- +,2+ not massive<500mg/dl
- non selective pr (>0.2 IgG/alb)
- Na+, Ca2+ reduced
- FeNa <0.5%Electrolyte, urea and creatinine.
Throat Swab-:
- grp A strept organism
- ASO >200 todds unit
Streptozyme:-
Complement:
- -C3
- FBC
- anaemia
Treatment
Goal
- Treatment of hypertension, eradication of organism
Hypertension:
- Tabs aldomet at a dose of 10mg/kg /dose in divided doses
- ACE inhibitors like Lisinopril
- Diuretics e.g. thiazides at 1-2 mg/kg /day in 2 divided doses
- Salt restriction
Diet:
- normal protein with 60-70% high biologic value but reduced to 0.6-1gm/kg in renal failure
Organism:
- Oral penicillin at a dose of 100mg/kg/day divided doses
- Cephalosporins
- Erythromycin a dose of 40-50mg/kg/day divided doses when there is penicillin allergy