GLOMERULONEPHRITISGLOMERULONEPHRITIS

DR.DR.

HANY ELSAYEDHANY ELSAYED

LECTURER OF PEDIATRICSLECTURER OF PEDIATRICS

GLOMERULONEPHRITISGLOMERULONEPHRITIS ( (Nephritic syndrome)

Hematuria Oliguria Oedema Hypertension

(A) Primary glomerulonephritis 1- Immune complex glomerulonephritis:

Post infectious glomerulonephritis: May follow infection with Strept, Staph, Pneumococci, HBV, Echo, Coxachie.

Membranoproliferative glomerulonephritis (MPGN).

IgA Nephropathy (Berger’s disease).

2- Anti glomerular basement membrane glomerulonephritis (Good–Pasteur syndrome).

3- Uncertain cause e.g. Focal segmental

glomerulonephritis.

(B)Glomerulonephritis with systemic disorders:

1- Immune mediated: Lupus nephritis. Systemic infection

e.g. infective endocarditis. Henoch Shönlein purpura.

2- Heriditary e.g. Alport syndrome.

ACUTE POST STREPTOCOCCAL

GLOMERULONEPHRITISGLOMERULONEPHRITIS

Acute Nephritic syndrome which follow infection with nephritogenic strain of group A- hemolytic streptococci

( 4, 12 causing throat infection or 49 causing skin infection).

Pathogenesis:

Streptococcal infection→ Antibodies.

↓Antigen + Antibody + Complement (C3) immune complexes

↓Deposited in glomerular basement membrane

↓

Acute inflammation

Acute inflammation

Proliferation of mesangealProliferation of mesangeal

and endothelial cellsand endothelial cells.. Glomerular endothelial damage Glomerular endothelial damage

Escape of Escape of RBCsRBCs (and proteins) in urine (and proteins) in urine

Glomerular capillaries obstructionGlomerular capillaries obstruction . .

Glomerular blood flowGlomerular blood flow..

↓↓

OliguriaOliguria , , OedemaOedema && ++ (JGA)++ (JGA)→ → Hypertension

Clinical picturePeak age : 3-7 years.

Skin or throat infection 1-3 weeks ago is followed by

1- Hematuria : Painless, cola colored (smoky) urine rarely gross hematuria.

2- Oliguria : Urine output (UOP) < 1 ml/kg/hr or < 400 ml/m2/day.

3- Hypertension : Transient , mild to severe.

4- Oedema : Mild, morning periorbital puffiness & pretibial oedema.

5- Non specific : Headache, vomiting, abdominal pain.

Complications

1-     Heart Failure Due to hypertension or hypervolemia.

2- Hypertensive encephalopathy Due to acute hypertension → punctuate cerebral hemorrhage & oedema

3- Acute Renal Failure(ARF) Due to rapidly progressive(crescentic)

glomerulonephritis

Differential diagnosis

From other causes of Hematuria

Investigations

Urine analysisElectrolytesRenal function tests Hemodilution(anemia) Low C3 (hypocomplementemia)Evidence of recent streptococcal infection

Renal biopsy

Treatment

Bed rest Antibiotic Diet Hypertension Treat Complications

Prognosis

95% recover completely 5% may end in chronic renal failure