Post-streptococcal glomerulonephritis
5754252
220637085
2008-06-20T20:42:52Z
41.232.223.101
{{Infobox_Disease |
Name = {{PAGENAME}} |
Image = |
Caption = |
DiseasesDB = 29306 |
ICD10 = |
ICD9 = {{ICD9|580.0}} |
ICDO = |
OMIM = |
MedlinePlus = 000503 |
eMedicineSubj = med |
eMedicineTopic = 889 |
MeshID = |
}}
In [[nephrology]], '''post-streptococcal glomerulonephritis''' is a disorder of the [[glomerulus|glomeruli]] ([[glomerulonephritis]]), or small blood vessels in the kidneys, following an [[streptococci]] [[infection]]. This condition is essentially defined as an inflammation of the kidneys.
A closely related term is "post-infectious glomerulonephritis", which accounts for infections by other agents. However, this term is used much less frequently.
==Pathophysiology==
The exact pathology remains unclear, but it is believed to be Type III [[hypersensitivity]] reaction. Immune complexes (antigen-antibody complexes formed during an infection) become lodged in the [[glomerular basement membrane]]. [[Complement system|Complement]] activation leads to destruction of the basement membrane. It has also been proposed that specific antigens from certain nephrotoxic streptococcal infections have a high affinity for basement membrane proteins, giving rise to particularly severe, long lasting antibody response.
==Presentation==
1)Haematuria:
- It may be microscopic and not identified by the patient.
- It may be macroscopic and lead to dark brown or smoky urine.
- Frank hematuria may occur in severe case.
2)Oliguria
-It means urine output is less than 400 ml/day (normally 600 to 2500 ml/day).
-May be not observed by the patient.
3)Odema
-Acute Onset.
-Mild to modest severity.
-Pitting edema.
-Starts in the eye lids and face then the lower and upper limbs then generalized ( Hydrocele,ascites.Pericardial and pleural effusion ).
-It may be migratory : appear in eye lid in the morning ,disaapear in the afternoon and reappear around the ankle in the ambulant patients by the end of the day.
4)Hypertension.
-It is usually mild to moderate .
-Hypertensive encephalopathy,heart failure and acute pulmonary edema may occur in severe cases.
-Pulmonary congestion and congested neck veins may be present, but usually due to salt and water retention and less commonly heart failure.
5)General
-Fever,headache,malaise,anorexia,nausea and vomiting.
-Pallor due to edema and/or anemia.
6)Acute renal necrosis due to injury of capillary or capillary thrombosis.
-Acute tubular obstruction by cast
=Mechanism of Oedma=
A)Decrease glomerular permeability.
B)Secondary hyperaldosteronism.
C)Hypoalbuminemia.
==Causes==
Post-infectious glomerulonephritis can be a complication of [[streptococcal pharyngitis]] (strep throat).
==Diagnosis==
Diagnosis rarely requires a renal biopsy since there is usually a classical clinical presentation.
There will be elevated levels of ASOT Ab and low complement levels in the blood.
== ==Differential Diagnosis==
1)Other causes of acute glomerulonephritis with hypocomplementaemia:
-Lupus nephritis
-Type 1 membranoproliferative glomerulonephritis.
-Bacterial endocarditis.
-Shunt nephritis
-Cryoglobulinemia
2)Nephrotic syndrome.
3)Other causes of generalized edema:
-Malnutrition
-Malabsorption
-Renal affection
-Liver cell failure.
-Right side heart failure.
-Angioneurotic edema
4)Other causes of hematuria. ==
==External links==
*[http://www.mayoclinic.com/health/post-infectious-glomerulonephritis/AN00629 Post-infectious glomerulonephritis] - [[Mayo Clinic]]
*[http://www.niaid.nih.gov/factsheets/strep.htm Group A Streptococcal Infections] - [[National Institute of Allergy and Infectious Diseases]]
{{Nephrology}}
[[Category:Kidney diseases]]
{{medicine-stub}}
[[pt:Glomerulonefrite pós-estreptocócica]]