Clinical & laboratory indications of secondary causes of GN

Known extra renal diseases that causes GN Infections –Post-streptococcal glomerulonephritis. –Bacterial endocarditis –Viral infections Immune diseases –Systemic Lupus erythematosus –Goodpasture's syndrome. –IgA nephropathy. Vasculitis –Polyarteritis –Wegener's granulomatosis

Post-streptococcal glomerulonephritis Definition: The patient suffers a strep infection 1-3 weeks before onset of GN organism: Group A beta-hemolytic Streptococcus More common in children

Group A streps ConditionsEx findingsInvestigations SepticaemiaFever, GI symp, Abdo pain, SOB, Tachy FBE, U&E, LP, swab, sputum sample Wound/ skin infections blistersSwab Tonsillitisred swollen tonsils, purulent exudate FBE Swab Scarlet fever rash on chest, neck, skin folds & inner thigh Throat culture, Rapid antigen test, Rapid DNA test Necrotising fasciitisFever, severe pain, swelling, heat, redness ?

Late complications Rheumatic fever, post-streptococcal glomerulonephritis ConditionEx findingsInvestigations Endocarditisabnormal heart rhythm, murmur (may indicate inflammation) ECG ECHO UTI dysuria, urgency, frequency ( ↓ vol), suprapubic pain +/- haematuria, loin pain, vomiting FBE U&E MSU Toxic shock fever, dizziness, confusion -no specific test- FBE U&E MSU Swabs – throat, vagina

Viral Infections HIV –Seroconversion/primary illness: 6-8wks after inf. Lasts 3 weeks, full recovery –Symp: fever, arthralgia, myalgia, lethargy, lymphadenopathy, sore throat, mucosal ulcers, & faint pink maculopapular rash –Neuro: headache, photophobia, myelopathy, neuropathy, rarer: encephalopathy –Lymphopenia w atypical reactive lymphocytes

Hep B/ C –Investigations: LFT, Bloods LFT Prodromal stage: Bilirubin is normal –Bilirubinuria –↑ Urinary urobilinogen –↑ ↑ AST/ ALT Icteric stage: Bilirubin reflects the level of jaundice –AST reaches a maximum >500 IU/L –ALP <300 IU/L

Haematological test –Leucopenia –Lymphocytosis –Rare: Coombs’ – positive haemolytic anaemia w. ass. Aplastic anaemia –Severe: PT time prolonged –↑ESR