Glomerulonephritis
Glomerulonephritis (GN) is an immunologically mediated disease, primarily affecting glomeruli of both the kidneys .
Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis) is inflammation of the tiny filters in your kidneys (glomeruli). Glomeruli remove excess fluid, electrolytes and waste from your bloodstream and pass them into your urine. Glomerulonephritis can come on suddenly (acute) or gradually (chronic).
Aetiological Classification:
1. Primary cause is unknown 80-90%
2. Secondary known cause of antigen 10-20%
Exogenous antigen
1. Microbial Bacteria: B- hemolytic streptococcus , streptococcus viridans ,pneumococcus and Brucella .
* Virus : Hepatitis B,Measles ,Epstein Barr virus
* parasite : Microfilaria
* Fungus
* Protozoal : malaria, Toxoplasma gondii infection
2. Non - Microbials
Heavy metals
Toxins : Tetanus toxoid
Foreign protein : ATS ,Antidiphtheria toxin
Endogenous antigens
Thyroglobin
Cryglobulin
ANA
DNA other nuclear antigen
Tumour associated antigen
Histological classification
GN may be one of the following forms , irrespective of whether the cause is primary or secondary.
1. Minimal change GN
2. Membranous GN
3. Mesangial proliferative GN
4. Diffusion proliferative GN
5. Membrano proliferative GN
Clinical of Glomerulonephritis
* isolated proteinuria
* Hematuria
* Acute Nephritic syndrome
* Nephrotic syndrome
* Chronic Renal failure/ Acute Renal failure
* Hypertension
Pathology
a. Immune -complex 90%
- circulation immune - complex
- Immune-complex formed in situ
b. Anti - glomerular basement membrane ( GBM) antibody
C. Lymphokine formation
Investigations
To define the clinical syndrome
a. Urine examination for Albumin ,RBCs ,Casts
b. Urinary protein and volume estimation for 24 hrs
C. Serum urea , creatinine, total protein, cholesterol.
To identify the cause
1. Haematological
TC,DC,ESR,Hb:BT,CT ,platelet count LE cells and DIC screen
2. Immunological anti nuclear antibody
- ANA titer
- Double standard DNA antibody
- ASO titer ,VDRL
- Complement C3,C4
3. Microbiology
- HBsAg .
- Throat Swab culture and sensitivity (C/S)
- Skin Swab. C/S
- Blood C/S
4. Renal biopsy and histological examination
To detect complications
X-ray of chest
ECG
The acute disease may be caused by infections such as strep throat. It may also be caused by other illnesses, including lupus, Goodpasture's syndrome, Wegener's disease, and polyarteritis nodosa. Early diagnosis and prompt treatment are important to prevent kidney failure.
Cause of GN
Acute GN
Acute GN can be a response to an infection such as strep throat or an abscessed tooth. It may be due to problems with your immune system overreacting to the infection. This can go away without treatment. If it doesn’t go away, prompt treatment is necessary to prevent long-term damage to your kidneys.
Certain illnesses are known to trigger acute GN, including:
strep throat
systemic lupus erythematosus, which is also called lupus
Goodpasture syndrome, a rare autoimmune disease in which antibodies attack your kidneys and lungs
amyloidosis, which occurs when abnormal proteins that can cause harm build up in your organs and tissues
granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis), a rare disease that causes inflammation of the blood vessels
polyarteritis nodosa, a disease in which cells attack arteries
Heavy use of nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve), may also be a risk factor. You shouldn’t exceed the dosage and length of treatment listed on the bottle without seeking advice from your primary care provider.
Chronic GN
The chronic form of GN can develop over several years with no or very few symptoms. This can cause irreversible damage to your kidneys and ultimately lead to complete kidney failure.
Chronic GN doesn’t always have a clear cause. A genetic disease can sometimes cause chronic GN. Hereditary nephritis occurs in young men with poor vision and poor hearing. Other possible causes include:
certain immune diseases
a history of cancer
exposure to some hydrocarbon solvents
As well, having the acute form of GN may make you more likely to develop chronic GN later on.
Management
a. General treatment
1. Bed rest : Not Necessary unless there is hypertension or severe edema
2. Diet
3. Fluid
4. Diuretics
5. Hypertension
6. Pulmonary edema
Note : if you want a note of above general treatment please open our other diseases blog spots.
Specific treatment
Basic principle of treatment:
1. To remove antigen
2. To suppress antibody
3. To remove antigen - antibody complex
Diagnosed of GN :
The first step in diagnosis is a urinalysis test. Blood and protein in urine are important markers for the disease. A routine physical exam for another condition can also lead to the discovery of GN.
More urine testing may be necessary to check for important signs of kidney health, including:
creatinine clearance
total protein in the urine
urine concentration
urine specific gravity
urine red blood cells
urine osmolality
Blood tests may show
anemia, which is a low level of red blood cells
abnormal albumin levels
abnormal blood urea nitrogen
high creatinine levels
Your doctor may also order immunology testing to check for:
antiglomerular basement membrane antibodies
antineutrophil cytoplasmic antibodies
antinuclear antibodies
complement levels
Results of this testing may show your immune system is damaging your kidneys.
A biopsy of your kidneys may be necessary to confirm the diagnosis. This involves analyzing a small sample of kidney tissue taken by a needle.
To learn more about your condition, you may also have imaging tests such as the following:
CT scan
kidney ultrasound
chest X-ray
intravenous pyelogram
complications associated with GN :
GN can lead to nephrotic syndrome, which causes you to lose large amounts of protein in your urine. This leads to a lot of fluid and salt retention in your body. You can develop high blood pressure, high cholesterol, and swelling throughout your body. Corticosteroids treat this condition. Eventually, nephrotic syndrome will lead to end-stage renal disease if it doesn’t come under control.
The following conditions can also occur due to GN:
acute kidney failure
chronic kidney disease
electrolyte imbalances, such as high levels of sodium or potassium
chronic urinary tract infections
congestive heart failure due to retained fluid or fluid overload
pulmonary edema due to retained fluid or fluid overload
high blood pressure
malignant hypertension, which is rapidly increasing high blood pressure
increased risk of infections
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