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4 out of 11

True about acute post streptococcal GN are all except? (LQ)

A Hypocomplementemia

B Recurrence is not a feature

C Immuno suppressive are used in the treatment

D Hypertension is a feature

Ans. C Immuno suppressive are used in the treatment
A. Acute Poststreptococcal GN (Ref. Harrison-18th edition, Edi, P- 2340)

1. Postinfectiousglomerulonephritis occur as asequelae of disease caused by bacteria, viruses, fungi, protozoa, and helminths.

2. The prototypical postinfectious glomerulonephritis is poststreptococcal glomerulonephritis.

3. It is most common cause of GN in childhood.

4. Nephritis develops 1 –3 weeks after pharyngeal (more common in winter) or cutaneous infection with (more common in summer ) ‘nephritogenic’ strains of group A beta – hemolytic streptococci.

5. Diagnosis depends on a positive pharyngeal or skin culture, rising antibody titers and hypocomplementemia.

6. Renal biopsy reveals diffuse proliferative GN.

B. Pathology. Diffuse proliferative disease with mesangial and endothelial hypercellularity.

Electron microscopy-dense deposits are seen in the subepithelial area (humps), sub endothelial area and intra membranous.

C. Clinical features and diagnosis

a. The typical clinical presentation is a sudden onset of hematuria and edema.

b. The characteristic, but not diagnostic, laboratory profile is azotemia, hypocomplementemia, hematuria, leukocyturia, and proteinuria. Supporting data include elevated titers of antistreptolysin 0, antihyaluronidase, and anti-deoxyribonuclease B antibodies, all of which suggest preceding streptococcal infection.

D. Clinical course and diagnosis

a. The typical course of acute disease is recovery, particularly among children.

b. The acute nephri­tis resolves with amelioration of edema and hypertension 1-3 weeks after onset.

c. Proteinuria may persist for several months, exacerbated by erect posture and exercise.

d. Microscopic hema­turia similarly disappears slowly over a period of several months.

e. Some patients advance to end-stage renal disease.

E. Therapy.

a. Hypertension must be treated aggressively,

b. Furosemide or bumetanide is required for the underlying edema-inducing disease.

c. Antibiotic - penicillin.

d. Prophylaxis following poststreptococcal glomerulonephritis is not indicated because recurrences are exceedingly rare.

e. Immunosuppressive agents or corticosteroids have no therapeutic role.

Extra Edge : Early treatment of pharyngitis does not prevent development of acute GN.

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