Acute G.N. (nephritic $)
It is a clinical syndrome ch.ch. by sudden onset (days) of haematuria, proteinuria, oligurea & hypertension and azotemia with RBCs casts, dysmorphic RBCs in urine , the proteinuria is a non nephrotic range proteinuria.


Causes

Usually, it develops 7-20 d. after strept. Infection (beta haemolytic Stept.) ( 1, 2, 4, 12 ,18, 25, 49 , 55, 57 , 60,).
Staph- pneumococei - viral.
SLE.
Vasculitis.

C/P

Oligurea as cell proliferation of glomerulus
¯GFR.
Hypert crises & Encephalopathy.
Hypert. Ht failure.
Edema mainly due to salt & H2O retention




Prognosis in post infectious G.N

In children : complete recovery 90 %.
Adult : complete recovery 50 %.
Some cases progress to rapidly prog. G.N.
chr. G.N.

investigation

Urea
­, Cr­, RBCs casts.
Proteins < 3 gm, sometimes > 3 gm.
Markers for SLE, ASOT, ANCA.
Biopsy,specially if there is rapidly progressive renal failure suggesting cresentric G.N (RPG.N)

ttt

1 –fluid chart. -control blood pressure.
-salt restriction. –protein restriction is required
only if severe uraemia occurs.
2-Rest for 3 wks.
3-symptomatic ttt.
4-Ab for 10 d. e.g. Ampicillin. for streptococcal infection.
5-ttt of other causes e.g. SLE.

Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)