Nephritic syndrome - Medicine - RDT

Topic: Nephritic Syndrome
Faculty: General Medicine
Course: BSc RDT - 2nd year

- Acute Nephritic Syndrome

- Definition, Causes, Pathogenesis, Clinical Features, Diagnosis and Treatment of Post streptococcal glomerulonephritis(PSGN)

- Hematuria, Proteinuria

1. NEPHRITIC SYNDROME Dr. Salman Ansari Kanachur Institute of Medical Sciences

2. Contents Glomerular diseases Glomerulonephritis: causes + pathogenesis Acute Nephritic Syndrome Post streptococcal glomerulonephritis(PSGN)

3. Glomerular diseases Glomerular diseases include: Acute nephritic syndrome Rapidly progressive glomerulonephritis Nephrotic syndrome Chronic nephritis Asymptomatic urinary abnormalities(hematuria, proteinuria or both)

4. Glomerulonephritis Definition : inflammation of glomeruli

5. Causes of glomerulonephritis Primary GN Secondary GN(systemic)

6. Causes of glomerulonephritis Primary GN Secondary GN(systemic) Acute proliferative GN Rapidly progressive(crescentic) GN MCD FSGS Chronic GN

7. Causes of glomerulonephritis Primary GN Secondary GN(systemic) Systemic Lupus Erythematosus (SLE) Diabetes mellitus Vasculitis disorders amyloidosis

8. Causes of glomerulonephritis Primary GN Secondary GN(systemic) Systemic Lupus Erythematosus (SLE) Diabetes mellitus Vasculitis disorders amyloidosis Acute proliferative GN Rapidly progressive(crescentic) GN MCD FSGS Chronic GN

9. 3rd category: hereditary disorders Alport syndrome Fabry disease Thin basement membrane disease

10. Pathogenesis It is immune complex-mediated Antigen attaches to antibody and forms antigen-antibody complex(or immune complex) This circulates in blood and reaches the glomerulus of kidney and causes inflammation In some cases, antibodies are produced against antigen of basement membrane - this is called anti-GBM antibody-induced glomerulonephritis

11. Acute Nephritic Syndrome Syndrome consisting of: Oliguria Hematuria RBC casts in urine Hypertension Edema proteinuria(not severe) Azotemia(high blood urea nitrogen) Post-streptococcal glomerulonephritis(PSGN) is a common cause of nephritic syndrome

12. Etiology of PSGN Causative organism : group A streptococcus(GAS) Occurs few weeks after streptococcus infection of pharynx(pharyngitis) or skin infection(impetigo) Immune complex-mediated - type III hypersensitivity reaction

13. Pathogenesis Antibodies produced in response to streptococci ↓ Combine with antigen and form antigen-antibody complex ↓ Circulate in blood and get deposited within glomeruli of kidney ↓ Cause inflammation - “glomerulonephritis”

14. Clinical features Children between 6-10 years of age Malaise, fever, nausea, oliguria Classic triad 1. hematuria(smoky or cola-coloured urine) 2. Periorbital edema 3. h ypertension Other: proteinuria(less than 3.5 g/day) In adults: sudden hypertension and elevation of BUN

15. PSGN Hematuria Edema Hypertension

16. Diagnosis High A nti-Streptolysin O( ASO) titer Low serum complement(C3) RFT: Elevated urea and creatinine Urinalysis : hematuria, RBC casts, mild proteinuria ☆ Renal biopsy: acute inflammation in glomerulus with neutrophils and immunoglobulin deposits

17. Treatment : Supportive treatment - rest Salt restriction Diuretics for edema Antihypertensives to control high BP Dialysis is done in severe oliguria and hyperkalemia

18. Complications of PSGN Rapidly progressive glomerulonephritis Pulmonary edema Hypertensive encephalopathy Renal failure

19. Short answers Hematuria : Presence of blood in urine Causes of hematuria : Post-streptococcal glomerulonephritis Alport syndrome IgA nephropathy Trauma Renal cell carcinoma

20. Proteinuria : presence of protein in urine Causes of proteinuria : Glomerulonephritis Diabetic nephropathy hypertension

21. Urine findings in glomerulonephritis : Oliguria Mild proteinuria Hematuria (smoky or cola-colored urine) Urine microscopy shows RBC casts

22. Questions: LE : SE : Acute nephritic syndrome or acute glomerulonephritis or post-streptococcal GN = all 3 are same SA : define hematuria 3 causes of hematuria urine findings in GN

23. For notes, click here or scan: References: Archith Boloor, Ramadas Nayak - Exam Preparatory Manual Questions: [email protected] For PPT, scan: