Glomerulonephritis


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

AETIOLOGY

1.INFECTIOUS DISEASE
post streptococcal glomerulonephritis, infective endocarditis ,syphilis , mumps, measles
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, penicillamine.

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 an 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’s.

CLINICAL FEATURES

ACUTE NEPHRITIC SYNDROME
-hematuria
-RED blood cell
oliguria
edema
-hypertension
– proteinuria
uremia

INVESTIGATION
-URINE MICROSCOPY red cell cast -cultures throat shows group A beta hemolytic streptococci

-anti streptolycin elevated
-a3level may be reduced
-urinary protein increased
-urea and creatinine elevated
-renal biopsy features of glomerulonephritis

TREATMENT

IT INCLUDES REST , SALT RESTRICTION ,DIURETICS, BOTH HYPERTENSIVES AND ANTIBODIES .
,-DIALYSIS is required in severe oliguria-fluid overload -and hyperkaliemia.
-steroids and cytotoxic drugs are of no value.
-complications include pulmonary edema-,hypertensive encephalopathy , and renal failure.