Glomerulonephritis | Medical Science Optional Notes for UPSC PDF Download

Acute Nephritic Syndromes

Clinical Presentation

• Characterized by hematuria (cola-colored urine).
• Presence of red blood cell casts.
• Pyuria.
• Mild to moderate proteinuria.
• Extensive inflammatory damage to glomeruli leads to a decline in GFR.
• Uremic symptoms occur with salt and water retention, resulting in edema and hypertension.

Differential Diagnosis

• Poststreptococcal glomerulonephritis.
• Subacute bacterial endocarditis.
• Lupus nephritis.
• Antiglomerular basement membrane disease.
• IgA nephropathy.
• ANCA small-vessel vasculitis.
• Granulomatosis with polyangiitis (Wegener's).
• Microscopic polyangiitis.
• Churg-Strauss syndrome.
• Henoch-Schonlein purpura.
• Cryoglobulinemia.
• Membranoproliferative glomerulonephritis.
• Mesangioproliferative glomerulonephritis.

Poststreptococcal Glomerulonephritis (PSGN)

• Pathophysiology:
  • PSGN is an immune-mediated disease.
  • Involves streptococcal antigens, circulating immune complexes, and complement activation.
  • Associated with cell-mediated injury.
• Epidemiology:
  • Typically affects children aged 2 to 14 years.
  • More prevalent in males.
• Precursors and Triggers:
  • Skin and throat infections, particularly with nephritogenic strains of streptococci.
  • Glomerular disease follows these infections.

Management

• Patients with mild oliguria and normal blood pressure can be managed at home, with close monitoring of blood pressure and dietary intake.
• Dietary restrictions, including sodium, potassium, and fluid intake, are necessary until blood urea levels decrease and urine output improves.
• Accurate measurement of urine output and daily weight, along with fluid restriction equal to insensible losses and 24-hour urine output, is essential for patients with azotemia.
• Diuretics, such as oral frusemide (1-3 mg/kg) for modest edema and IV frusemide (2-4 mg/kg) for pulmonary edema, are part of the treatment.
• Mild hypertension can be controlled by restricting salt and water intake, and antihypertensive agents like amlodipine, nifedipine, or diuretics may be effective.
• For left ventricular failure, controlling hypertension and administering IV frusemide for diuresis can improve heart failure. Dialysis may be initiated if diuresis is not observed.
• Antibiotic treatment for streptococcal infection is recommended for all patients and their cohabitants.
• There is no role for immunosuppressive therapy in acute post-streptococcal glomerulonephritis.
• Overall, the prognosis is favorable, with permanent renal failure being very rare, occurring in less than 1% of children.

Glomerulonephritis-Repeats

Q: A 10 year old girl child has developed general anasarca, cola coloured urine and blood pressure of 240/120 mm of Hg. Give differential diagnosis; mention names of investigations and give an outline of management of this patient. (2003)