1. GLOMERULONEPHRITIS DR. HANY ELSAYED LECTURER OF PEDIATRICS

4. GLOMERULONEPHRITIS ( GLOMERULONEPHRITIS (Nephritic syndrome) Hematuria Oliguria Oedema Hypertension

5. (A) Primary glomerulonephritis 1- Immune complex glomerulonephritis:  Post infectious glomerulonephritis: May follow infection with Strept, Staph, Pneumococci, HBV, Echo, Coxachie.  Membranoproliferative glomerulonephritis (MPGN).  IgA Nephropathy (Berger ’ s disease).

6. 2- Anti glomerular basement membrane glomerulonephritis (Good – Pasteur syndrome). 3- Uncertain cause e.g. Focal segmental glomerulonephritis.

7. (B)Glomerulonephritis with systemic disorders: 1- Immune mediated:  Lupus nephritis.  Systemic infection e.g. infective endocarditis.  Henoch Sh ö nlein purpura. 2- Heriditary e.g. Alport syndrome.

8. GLOMERULONEPHRITIS ACUTE POST STREPTOCOCCAL GLOMERULONEPHRITIS

9. Acute Nephritic syndrome which follow infection with nephritogenic strain of group A- hemolytic streptococci ( 4, 12 causing throat infection or 49 causing skin infection).

10. Pathogenesis: Streptococcal infection → Antibodies. ↓ Antigen + Antibody + Complement (C3) immune complexes ↓ Deposited in glomerular basement membrane ↓ Acute inflammation

11. Proliferation of mesangeal and endothelial cells. Glomerular endothelial damage  Escape of RBCs (and proteins) in urine  Glomerular capillaries obstruction.   Glomerular blood flow. ↓ ↓ Oliguria, Oedema & ++ (JGA) → Oliguria, Oedema & ++ (JGA) → Hypertension

13. Clinical picture Peak age : 3-7 years. Skin or throat infection 1-3 weeks ago is followed by 1- Hematuria : Painless, cola colored (smoky) urine rarely gross hematuria. 2- Oliguria : Urine output (UOP) < 1 ml/kg/hr or < 400 ml/m2/day. 3- Hypertension : Transient, mild to severe. 4- Oedema: Mild, morning periorbital puffiness & pretibial oedema. 5- Non specific: Headache, vomiting, abdominal pain.

15. Complications 1- Heart Failure  Due to hypertension or hypervolemia. 2- Hypertensive encephalopathy  Due to acute hypertension → punctuate cerebral hemorrhage & oedema 3- Acute Renal Failure(ARF)  Due to rapidly progressive(crescentic) glomerulonephritis

16. Differential diagnosis From other causes of Hematuria

17. Investigations Urine analysis Electrolytes Renal function tests Hemodilution(anemia) Low C3 (hypocomplementemia) Evidence of recent streptococcal infection Renal biopsy

18. Treatment Bed rest Antibiotic Diet Hypertension Treat Complications

19. Prognosis 95% recover completely 5% may end in chronic renal failure