ACUTE glomerulonephritis.pptx in young children

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1. ACUTE GLOMERULONEPHRITIS

2. AGN-Definitions Inflammatory process affecting primarly the glomerulus , with infiltration and proliferation of acute inflammatory cells,which is characterized by sudden onset of hematuria olig.uria , edema and hypertension.

3. Incidence APSGN is the commonest glomerulonephritis affecting children.( nephrogenic strains of Group A streptococcus) Common among 5-12 yrs of age . 2-4 % of pediatric admissions.

4. Etiology Post infection:Streptococci,staphylococci , pneumococci,meningococci,salmonella and treponema hep B nd C,EBV,coxasackie virus,infection of shunts and infective endocarditis . Systemic vasculitis : microscopic poly arthritis. Others:SLE,IgA nephropathy,membreno proliferative glomerulonephritis .

5. Pathophysiology Streptococcal infection produces an immune response by forming antibodies which combine with antigens to produce antigen-antibody complex. When these complexes pass through the circulation get trapped in the glomerulus and activate an inflammatory response in the glomerular basement membrane.

6. Contd …. The products of the inflammatory response damage the glomerular capillaries and and reduce the size of the capillary lumen. Decreased glomerular filtration rate Renal insufficiency Edema,oliguria due to fluid retension Injury to capillary walls- RBC,cast and protein pass through the urine

7. Clinical features Edema : puffiness of face,peri orbital and pedal edeme Mild proteinuria Hematuria Oliguria Hypertension Fever malaise and loin pain History of sore throat or pyoderma 1-3 weeks before

8. Atypical presentation of AGN are convulsions,left ventricular failure,pulmonary edema,acute kidney injury and nephrotic syndrome

9. Phases Latent phase Acute phase Recovery phase Triad of symptoms of PSAGN Edema Hematuria Hypertension

10. Diagnosis Urine:RBC,casts,neutrophils and albumin1 -2+ Blood: raised urine creatine,low sodium,high potassium, raised ASO titre . Renal biopsy in severe cases

11. Treatment Diuretics: edema-Frusemide1-3mg/kg Hypertension: Fluid and salt restriction, antihypertensives-amlodipine,nifedipine or diuretics. Oliguria : blood urea and electrolytes are monitored .Dialysis in severe cases.

12. Contd …. Left ventricular failure : IV frusemide,dialysis and respiratory support. Diet: sodium, potassium and fluid are restricted until blood uea decreases and urine out put increases.

13. Nursing management Interventions include Maintaining fluid volume Promoting rest and activity Maintaining skin integrity Maintaining nutrition Reducing anxiety