Written by Dr.Md.Redwanul Huq (Masum)

Tuesday, 22 January 2013  9:44

Definition of Acute Nephritic Syndromes:

These syndromes are presented with hematuria, hypertension, edema (due to salt and water retention) and oliguria (reduced urine volume). There are also red blood cell casts, pyuria, reduction of GFR (Glomerular Filtration Rate), mild to moderate proteinuria.

Causes of Acute Nephritic Syndromes:

I. Infectious diseases-

1. Poststreptococcal glomerulonephritis (Mostly by Group A Beta Hemolytic Streptococcus)
2. Others (Non-Poststreptococcal glomerulonephritis)-

a)Bacterial-

i) Subacute bacterial endocarditis
ii) Meningococcemia
iii) Syphilis
iv) Leprosy

b) Viral-

i) Hepatitis B
ii) Hepatitis C
iii) Mumps
iv) Measles
v) HIV
vi) Epstein bar virus

c) Parasitic-

i) Malaria
ii) Schistosomiasis
iii) Toxoplasmosis
iv) Leishmaniasis

II. Primary glomerular diseases-

1. Membranoproliferative glomerulonephritis
2. IgA nephropathy
3. Mesangioproliferative glomerulonephritis
4. Antiglomerular basement membrane disease

III. Systemic diseases-

1. Systemic lupus erythematosus (SLE) resulting Lupus nephritis
2. Henoch-Schönlein purpura
3. ANCA (Antineutrophil cytoplasmic antibodies) small-vessel vasculitis

IV. Others-

1. Wegener’s granulomatosis
2. Microscopic polyangiitis.

Acute Poststreptococcal glomerulonephritis

Definition:

Acute Nephritic Syndrome following infection with Streptococcus which is characterized by hematuria (resulting red or smoky urine), hypertension, edema and oliguria. Acute Poststreptococcal glomerulonephritis usually affects children between 2 and 14 years of ages and develops 2 – 6 weeks following skin infection and 1 – 3 weeks following streptococcal pharyngitis.

Symptoms:

1. Passage of red or smoky urine
2. Swelling of the body (usually begins in the face)
3. Scanty micturition, may with burning sensation
4. Fever
5. Headache
6. Loss of appetite
7. Malaise
8. Flank pain

Signs:

• Swollen face (Puffy face)
• Temperature- raised
• Anemia- may be present due to hematuria and hemodilution
• Blood pressure- increased
• Bed side urine test- Urine color red or smoky, Heat coagulation test positive
• Skin infection- may be present
• Evidence of pharyngitis – if occurs
• Signs of complication(s)-if develop(s)

 Investigations:

1. Blood-

a) Serum C3- decreased, C4- normal
b) TC- increased, Neutrophil- increased, Hb%- decreased, ESR- increased
c) Antistrepto-lysin O (ASO), anti-DNAase antibody or antihyaluronidase antibody titre- high
(in case of streptococcal infection)
d) Rheumatoid factor- may be positive
e) Blood urea, Serum creatinine- increased in renal failure
f) Serum electrolyte- Na+ decreased and K+ increased

2. Urine-

a) Urine R/M/E-

•  Color- red or smoky
• Volume- increased
• RBC- plenty (dysmorphic)
• RBC casts- present
• Protein- +/++

b) 24 Urinary Total Protein(UTP)- less than 3.5 gm/ 24 hours.

3. Others-

a) Throat swab for Gram staining and culture
b) Swab from skin lesions (if present) for Gram staining and culture

4.To exclude complications-

a) Chest X-Ray
b) ECG

Treatment of Acute Poststreptococcal glomerulonephritis:

Usually starts to resolve spontaneously within 10-14 days. Following treatment is given as supportive therapy-

•  Bed rest
• Diet-

1. Sodium restriction
2. Fluid restriction- Previous day output + 400 ml/m² surface area

• Maintenance of intake-output chart
• Diuretics (e.g. Frusemide) for control of edema
• Anti-hypertensive (e.g. Captopril, Nifedipine) for control of hypertension
• Antibiotic (e.g. Cefixime, Amoxicillin, Erythromycin) for control of streptococcal infection
• Treatment of complication(s) of Acute Poststreptococcal glomerulonephritis
• Other measures are-

1. Regular monitoring of Blood pressure
2. Maintenance of weight chart
3. Regular measurement of abdominal girth
4. Bedside heat coagulation test to monitor proteinuria.