Nephritic Syndrome by S.Wangdi

-mainly glomerulus affected.

-podocytes defective

                     

-Clinical  features:

                 1.haematuria-rbc casts

                 2.hypertension

                 3.proteinuria<3.5g/24hr

                 4.Oliguria <400ml/day

                 5.uraemia

                 6.azotaemia

Diagnosis

             .-Anti-streptolysin O titre/ASO titre(for post streptoccal infection only)

              -renal biopsy 

                                -focal--IgA nephropathy, Alport syndrome(hereditary nephritits, henoch scholein purpura, SLE,

                                -diffused

                                             -membranoproliferative, rapidly
progressive nephropathy,SLE, 

             

Causes:

          

1.Primary-minimal changes, RPGN, membranous GN,
                          -further divided into focal and diffused

2.Secondary--SLE, post streptococcal infection,

Proliferative basis:

Proliferative-thickening or thinning plus proliferation of mesangial cells.
                                                   - IgA nephropathy(upper GI and RS infection)-->IgA deposit and proliferation
                                                    -membrano-proliferative nephropathy..
                               

Non Prolifrative -only thickenin and thinning

                       -minimal change-GN-podocyte abnormal in electron microscope, FSGN, membranous glomerulous nephritis

Poststreptococcal Glomerulonrhritis

Pathology 

         After infection---Ag+Ab reaction--->immune complex--->lodged in glomerulus---->inflammation------->destruction BM

clinical features:
         -haematuria--smoky brown urine, in severe case, blood
         -oliguria<400ml/day
          -hypertension
          -oedema, pitting,--->generalised edema-->migratory edma
       
General features:
headache, fever, nausea,
signs of acute renal failure

Treatment.
antihypertensive
reduced salt intake
dialysis
corticosteroid
in certain case, penicillin prophylaxis

Rapidly Progressive Glomerulonephritis(creasent GN)

rapidly loss of kidney function(50% decline in GFR within 3 months with creasent seen in 50-75%)

PATHOLOGY
antibodies against GBM or immune complex or the neutrophil are deposited in the bowman's space and rapidly deteriotes kidney function.

SIGNS
1. severe hameturia
2. RBC cast
3. Proteinuria(>3g/day)
4. odema
5.oligouria.

CLASSIFICATION(based on immunoflorescent pattern)
1. type 1(20%).. linear pattern
            Ab against GBM esp collagen IV
            eg. Good Pasture Syndrome

2. Type 2(25%).. granular pattern
            Ab against immune complex deposition
            eg. SLE, HSP, IgA nephropathy

3. Type 3(55%).. pauci immune
            by neutrophil... no Ab

DIAGNOSIS
    i. Renal biopsy
    ii. Serum analysis..(anti GBM Ab, antinuclear Ab, ANCA)

TREATMENT
    1. plasmapheresis
    2. corticosteriod
    3. cytotoxic
    4. dialysis
    5. transplant