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]]