Acute Glomerulonephritis


It is glomerular inflammation in which there is an immunological mediated injury to the glomeruli.





Etiology





1.infectious disease





Post streptococcal glomerulonephritis, Infective endocarditis, Syphilis, mumps, Hepatitis B, infectious mononucleosis, Epstein-Barr virus.





2.Multi system disease





SLE, Good pastures syndrome, Henoch-Schonlein purpura, Sickle cell nephropathy.





3.Primary glomerular disease





Diffuse proliferative glomerulonephritis, IgA nephropathy, Mesangiocapillary glomerulonephritis, Crescentic glomerulonephritis ,Membranous  glomerulonephritis, Focal segmental  glomerulonephritis.





4.Miscellaneous – Malignancy, Eclampsia, Penicilamine.





Pathogenesis





Two mechanism are involved





-Deposition of antigen -antibody complexes in glomeruli resulting in glomerular disease.





-Deposition of an antibody in the glomerular basement membrane which them reacts with an antigen in the basement membrane causing glomerulonephritis.





Normally the immune complexes formed in the body are removed as the host reticuloendothelial system. This impaired ability for this results in their deposition in the glomerular basillary walls.





-The antigen may be exogenous or endogenous.





Mechanism for immune complexes and antibodies against glomerular injury are: –





-Complement activation.





-Fibrin deposition.





-Platelet aggregation.





-Release of cytokine and free oxygen radical.





Clinical features





Acute nephritic syndrome





-Hematuria.





-Red blood cell.





-Oligouria.





-Odema.





-Hypertension.





-Proteinuria.





-Uraemia.





Investigations





-Urine microscopy red cell cast.





-Cultures throat shows group a beta hemolytic streptococci.





-Anti streptolysin elevated.





-Urinary protein increased.





-Urea and creatinine elevated.





-Renal biopsy features of glomerulonephritis.





Treatment





It includes rest, salt restriction, diuretics, both anti-hypertensives and antibiotics.





-Dialysis is required in severe oliguria-fluid overload and hyperkalemia.





-Steroids and cytotoxic drugs are of no value.





-Complications include pulmonary oedema, hypertensive encephalopathy, and renal failure.