Acute glomerulonephritis is defined as inflammation and subsequent damage of the glomeruli leading to hematuria, proteinuria, and azotemia; it may be caused by primary renal disease or systemic conditions
It is a disorder of structure and or a functional anomaly of an abrupt onset with a tendency to spontaneous recovery
It may be acute or chronic.
Chronic type is a common cause of end-stage renal disease in children.
It could be caused by post streptococcal
glomerulonephritis, diffuse proliferative
glomerulonephritis, mesangial proliferative glomerulonephritis, focal
segmental glomerulosclerosis, membranous glomerulopathy, rapidly progressive glomerulonephritis, systemic illness, SLE, Henoch Schonlein Purpura, HBV, poly arteritis nodosa
The commonest cause in this environment is post streptococcal
History of passage of dark smoky urine,
preceding sore throat, skin infection, facial or pedal oedema, seizure, oliguria, anorexia.
Hypertension, oedema, respiratory distress in presence of severe fluid accumulation, seizures, hypertensive encaphalopathy
- Gross hematuria, hypertension, oliguria are the hall mark of diagnosis
- Hypertensive encephalopathy, acute kidney injury, hyperkalemia, fluid overload, congestive cardiac failure
- colour- dark smoky urine.
- Red cell casts commonly may be absent and repeated urinalysis of fresh urine may be needed
- waxy-suggest pre existing nephritis
- pr-+,2+ not massive <500mg/dl
- non selective pr (>0.2 IgG/alb)
- Na’, Ca2′ reduced
- FeNa <0.5%
- Electrolyte, urea creatinine.
- grp A strept organism
- ASO>200 todds unit. Streptozyme:
- Complement: -C3
- FBC – anaemia
- Treatment of hypertension,
- Eradication of organism
- Tabs aldomet at a dose of 10mg/kg/dose in divided doses
ACE inhibitors like lisinopril
Diuretics e.g. thiazides at 1-2 mg/kg/day in 2 divided doses
- Salt restriction
- Diet: normal protein with 60-70% high biologic value but reduced to 0.6-1gm/kg in renal failure
- Oral penicillin
- at a dose of 100mg/kg/day in divided doses
- at a dose of 40- 50mg/kg/day in divided doses when there is penicillin allergy