Common Pediatric Disorders

Acute Nephritic Sydrome

Posgt streptococcal glomerulonephritis

Acute glomerulonephritis

ETIOLOGY :

                Inflammatory complex :

1.       Infection by streptococcal beta-hemolatic

2.       Complex Ag-Ab attack of basement menbrane

3.        Toxin effect of streptococcal to basement membranous glomerula.

PATHOPHYSIOLOGY :

                karksÞH enA Glomerula eday Complex Ag-Ab eFVIeGay 

-          Inflammmation  ( Hematuria , proteinuria )

-          Bi)akeRcaH ( Edema , Oliguria )

-          Hypertesion (Increase afferent artery pressure )

CLINICAL SIGNS

·         Post Streptococcal infetion of pharynx

-          Fever

-          Sore throat

-          Malaise

-          Abdomonal Pain

·         Acute glomerular inflammation

-          Sudden onset 1-7 days

-          Oliguria ( Urine < 400ml / day prognosis to acute renal failure )

-          Edema

-          Proteinuria non selective and hematuria

-          Hypeertesion

PARACLINC

·         CBC

·         BUN (Blood Urea-Nitrogen )

·         ASLO positive

·         Urinalysis

-          Proteinuria non selective

-          Erythrocyte cast

-          Leukocyturia

-          Hyaline , glanular

·         3 Serologic markers

-          Serum C3 level

-          Anti glomerula  basement membrane antibody ( AGBM antibody )

-          Anti nucleo cytoplasmic antibody ( ANC antibody )

·         Renal ultrasonography

·         Renal biopsy

COMPLICATION

·         Anemia

·         Hyperkalemia

·         Acute renal failure

·         Chronic renal failure evolution to ESRD

DIFFERENTIAL DIAGNOSIS

·         Nephrotic syndrome

·         Henoch Schonlein purpura ( Rheumatiod purpura )

·         Lupus nephritis

·         Berger’s disease ( Ig A nephropathy )

·         Wegener’s Granulomatosis : Vasculitis associated with

-          Glomerulonephritis

-          Resporatory symptom : Cough , dyspnea , chronic sinusitis , otitis media , hemoptysis .

-          Neuropathy , purpura , arthritis , scleritis

-          Conformed diagnosis : C_ANCA , large nodular by chest x-ray , hematuric , and biopsy .

-          Treat by corticoide or cyclosporine and cotrimoxazole

MANAGEMENT

1.       Supporting diet and vitamin B

2.       Edema and hyperkaliema Furosemide 1mg / kg / dose

3.       Hypertesion ( Calcium channel blocker )

4.       Antibiotherapy

    Ceftriaxone 100mg / kg / day

5.       Follow up every  month  , ASLO test ?

      Extrancilline 2.4 millions / month

References

Current essentials of medicine

MERCK MANUAL , medicine information