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| Acute glomerulonephritis |
Acute glomerulonephritis
it is glomerular inflammation in which there is an immunological mediated injury to the glomeruliAETIOLOGY
1.INFECTIOUS DISEASE
post streptococcal glomerulonephritis, infective endocarditis ,syphilis , mumps,nearles
hepatitis b ,infectious mono nucleosis,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 ,crescentib 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 gloodrtlitis
Normally the immune complexes formed in the body are removed an the host reticulodndithelial 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
INVESTIGATION
-URINE MICROSCOPY red cell cast -cultures throat shows group A beta haemolytic streptococci
-anti streptolysin 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 oligouria-fluid overload -and hyperlalaemia.
-steroids and cytotoxic drugs are of no value.
-complications include pulmonary oedema-,hypertensive encephalopathy , and renal failure.
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