Definition

acute glomerunephritis
This is characterised by
azotaemia,hypertension,oedema,haematuri
a,proteinuria and oliguria ,salt and water
retention from reduced GFR
• And circulatory congestion
• Presence of RBC casts in urine
• Proteinuria may be up to 3mg or less
 Clinical syndrome

• Acute nephritic syndrome

• Nephrotic syndrome
• Renal failure acute or chronic
• Asymptomatic proteinuria and or
microscopic haematuria
 causes
• Primary glomerular diseases
• Mesangiocapillary GN
• Berger disease (IgA nephropathy)
• Mesangial proliferative GN
 Infectious disease
• Poststreptococcal GN
• Nonstreprococcal postinfectious GN 1Bacterial
Infective endocarditis,sepsis,pnuemonia,typhoid
fever,meningococcemia,secondary syphilis
2Viral-hepatitisB,infectious
mononucleosis,mumps,measles,varicella,vacci
nia,echovirus,cocksackievirus 3 Parasitic
malaria,toxoplasmosis
 Multisystem disease
• Systemic lupus erythematosus
• Vasculitis
• Henoch- schonlein purpura
• Goodpasture s syndrome
 miscellaneous
• Gullain Barre syndrome
• Irradiation of wilms tumour
• Diphtheria ,pertussis, tetanus vaccine
• Serum sickness
 Prototype of AGN
acute poststreptococcal GN
• Most common in childhood
• Kidney disease in 1-3 weeks after pharyngeal
or cutaneous infection with nephritogenic
strains of group A beta haemolytic streptococi
• Diagnosis - history of preceding sore throat
or skin infection, fever, body swelling ,passage
of smoky or coke coloured urine,oligo
anuria ,hypertension, renal failure
• investigation
 investigation
• Urine analysis-macroscopy and microscopy
for rbc casts,24 hour urinary protein excretion
• Blood – creatinine clearance
urea,creatinine,electrolytes,albumin,antistrept
olysin-O titre, blood glucose
• Anti nuclear,anti ds DNA,ANCA,antiglom
basement antibody,hepatitis
B,C,antibody,Hiv,cryoglobulin
• Chest Xray
• Renal biopsy
 treatment
• Bed rest
• Salt and fluid restriction
• Diuretics
• management of hypertension
• Course of antibiotic
• Dialysis
 complications
• Susceptibility to infections
• Acute left ventricular failure and pulmonary
oedema
• Hypertensive encephalopathy
• Fluid and electrolyte imbalance
• Acute renal failure
• Nephrotic syndrome
• Chronic glomerunephritis
 Rapidly progressive GN
• Gradual onset of haematuria,proteinuria,and
renal failure
• Progressing over weeks to months
• Crescentric GN on renal biopsy
• 50% of cases require dialysis within 6months
 Causes of rapidly progressive GN
immune complex GN 45%
• Idiopathic proliferative GN
• Mesangio proliferative GN
• Postinfectious Gn,Crescentric GN
• Lupus nephritis
• Cryoglobulinaemia
• Bacterial endocarditis
• IgA nephropathy,Henoch Schonlein purpura
 Pauci immune complex GN45%
• Wegeners granulomatosis
• Microscopic polyateritis
• Drugs -ciprofloxacin
 AntiGBM 10%
• Goodpasture disease
 SLE
lupus nephritis
• Due to deposition of immune complexes
• Clinical features are arthralgias,skin
rash,serositis,hair loss,and CNS symptoms
• Diffuse GN common manifesting as elevated
ESR ,severe proteinuria and progressive renal
insufficiency
• ANCA positive,antids DNA, low complement
• Treatment include glucocorticoid and
cytotoxicagents
WHO lupus nephritis classification
• Class1 normal biopsy and light microscope occasional mesangial
deposit in immmunofloresensce
• Class11 mesangial lupus nephritis
• Class 111 focal segmental lupus nephritis
• class1V diffuse proliferative lupus nephritis
• Class V menbranous lupus nephritis
• Class V1 ESRD
• Treatment class 1and most cases of 11 no treatment but class 111
and 1V glucocorticoid and immunosuppressive agents
IgA nephropathy (Bergers Disease)
• Most common form of primary glomerular
disease world wide
Progression to ESRD in 20 to40% of cases over
20years
Gross intermittent haematuria
Abnormal proteinuria
Mesangial IgA
 Chronic GN
• Characterised by persistent urinary
abnormalities
• Slow progressive impairment of renal function
• Symmetrically contracted kidneys
• Moderat e to heavy proteinuria
• Abnormal urinary sediments esp RBC
• Time to progression to ESRD is variable hastened
by uncontrolled hypertension and infections