ACUTE GLUMERULONEPHRITIS

Acute glomerulonephritis is characterized by the sudden appearance of hematuria,

proteinuria, red blood cell casts in the urine, edema, and hypertension with or without
oliguria. It can follow streptococcal infections. This illness was first recognized as a
complication of the convalescence period of scarlet fever in the 18th century.1 A link between
hemolytic streptococci and acute glomerulonephritis was recognized in the 20th century.

Glomerulonephritis (nephritic syndrome) is a disorder of glomeruli (clusters of microscopic

blood vessels in the kidneys with small pores through which blood is filtered). It is
characterized by body tissue swelling (edema), high blood pressure, and the presence of
red blood cells in the urine.

The kidneys are bean-shaped organs located in the back just below the rib cage. Each
kidney is about the size of a fist. The two kidneys filter blood, catch needed substances and
return them to the circulation, and dispose of wastes in the urine. If the kidneys don’t filter
properly, wastes build up in the blood.

 Glomerulonephritis can be caused by various disorders, such as infections, an

inherited genetic disorder, or autoimmune disorders.
 People may have tissue swelling, headaches, visual disturbances, and seizures.
 Diagnosis is based on tests of blood and urine and sometimes imaging tests, a
biopsy of the kidneys, or both.
 People need to restrict salt and protein intake and take diuretics or antibiotics until
kidney function improves.

Acute glomerulonephritis that develops into rapidly progressive glomerulonephritis

most often results from conditions that involve an abnormal immune reaction.

A person with acute glomerulonephritis has inflammation of the blood vessels in the
kidney, which causes the kidneys to malfunction. The most common cause of acute
glomerulonephritis is throat infection with the bacteria, Streptococcus.

CAUSES

Causes of glomerulonephritis include:

 Streptococcal infection of the throat ( strep throat) or skin ( impetigo)

 Hereditary diseases
 Immune diseases, such as lupus
 Type 1 diabetes and Type 2 diabetes
 High blood pressure
 Vasculitis (inflammation of the blood vessels)
 Viruses ( HIV, hepatitis B virus, and hepatitis C virus)
 Endocarditis (infection of the valves of the heart)
SIGNS AND SYMPTOMS OF ACUTE GLUMERULONEPHRITIS

1. Hematuria

Hematuria is the presence of red blood cells (RBCs) in the urine. In

microscopic hematuria, the urine appears normal to the naked eye, but examination with a
microscope shows a high number of RBCs. Gross hematuria can be seen with the naked
eye—the urine is red or the color of cola.

2. Hypertension
Hypertension is thought to be the result of excessive salt and water retention.
When hypertension is caused by another condition or disease process, it is called
secondary hypertension.

3. Dark urine (brown-, tea-, or cola-colored)

a. This is often the first clinical symptom.
b. Dark urine is caused by hemolysis of red blood cells that have penetrated the
glomerular basement membrane and have passed into the tubular system.

4. Periorbital edema
a. The onset of puffiness of the face or eyelids is sudden. It is usually prominent
upon awakening and, if the patient is active, tends to subside at the end of the
day.
b. In some cases, generalized edema and other features of circulatory
congestion, such as dyspnea, may be present.
c. Edema is a result of a defect in renal excretion of salt and water.
d. The severity of edema is often disproportionate to the degree of renal
impairment.
5. Oliguria
o Reduced volume or strength of urine output.
o This is present in 10-50% of cases, and, in 15%, urine output is less than 200
mL.
o Oliguria is indicative of the severe crescentic form of the disease.
o It is often transient, with diuresis occurring within 1-2 weeks.

PREDISPOSING FACTORS

A. Autoimmunity:  
When the body's immune system functions properly, it creates protein-like substances called
antibodies and immunoglobulins to protect the body against invading organisms. In an
autoimmune disease, the immune system creates autoantibodies, which are antibodies or
immunoglobulins that attack the body itself. Autoimmune diseases may be systemic and
affect many parts of the body, or they may affect only specific organs or regions. 

B. Heredity:
  Sometimes this disease runs in families –
This kind often shows up in young men who may also have hearing loss and vision loss.

C. Infective :
Glomerular disease sometimes develops rapidly after an infection in other parts of the body.
D. Sclerotic diseases:  
This means scarring of the glomeruli by various sysytemic and local causes. Example :
Diabetes, Lupus disease etc.

E. Idiopathic: 
Meaning, arising spontaneously or from an obscure or unknown cause.