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Poststreptococcal Glomerulonephritis

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Light Microscopy. On light microscopy, usually see diffuse proliferative GN. Immunofluorescence Microscopy. Deposition of IgG and C3. 3 ... Electron Microscopy ... – PowerPoint PPT presentation

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Title: Poststreptococcal Glomerulonephritis


1
Poststreptococcal Glomerulonephritis
  • Nirav Dhruva
  • Morning Report
  • July 2005

2
Poststreptococcal GN (Introduction)
  • Usually occurs 10 days after pharyngitis and 14
    days after skin infection
  • (not synpharyngitic)
  • Fallen incidence in US, but common in some rural
    areas, poor hygiene places, and tropical
    countries
  • Occurs more often in males and children

3
Poststreptoccal GN (nephritic strains)
  • Known nephritic strains include M types 1, 2, 4,
    12, 18, 25, 49, 55, 57, 60
  • Many proposed mechanisms Molecular mimickry vs.
    autoimmune vs. polyclonal activation of B
    lymphocytes
  • Repeat infections are not common as immunity is
    type specific and not usually transient

4
Clinical Presentation
  • Most patients have milder disease
  • Classically, presents with overt nephritic
    syndrome and oliguric ARF
  • Symptoms can include gross hematuria (100
    microscopic), HA, htn (60-80), hypervolemia, and
    edema (80-90)

5
Clinical Presentation
  • Nephritic urinary sediment dysmorphic RBCs, red
    cell casts, leukocytes, subnephrotic proteinuria
  • Nephrotic-range proteinuria not common

6
Labs
  • Serum Cr can be commonly elevated at
    presentation, though mild
  • C3 and CH50 decreased w/in 2 weeks
  • C4 usually normal (complement level usually
    normal within 6-8 weeks)
  • Most patients have directed Ab, such as ASO,
    anti-DNAse B, etc
  • Serum IgG and IgM increased in 80 and returns to
    normal in 1-2 months
  • Polyclonal cryoglobulinemia in 75

7
Light Microscopy
  • On light microscopy, usually see diffuse
    proliferative GN

8
Immunofluorescence Microscopy
  • Deposition of IgG and C3

9
Electron Microscopy
  • large electron dense immune deposits in
    subendothelial, subepithelial, and mesangial areas

10
Course
  • Irreversible Renal Failure rare less than 1
    in children, slightly higher in adults
  • Resolution usually quick, plasma Cr usually
    returns to previous levels by 3-4 weeks
  • Hematuria resolves usually within 3-6 months,
    proteinuria falls at a slower rate
  • Some patients experience htn, recurrent
    proteinuria, and renal insufficiency 10-40 yrs
    after
  • gt 20 of adults may have some degree of
    persistent proteinuria and or compromise of GFR 1
    year out

11
Treatment
  • Eliminate strep infxn with abx
  • Supportive therapy
  • Diuretics and antihypertensives to control bp and
    extracellular fluid volume

12
Acute GN and Pulmonary Hemorrhage
  • ANCA associated systemic vasculitis and anti-GBM
    - common causes
  • Also reported to occur in SLE, HSP, mixed
    Cryoglobulinemia
  • Study of 88 patients with Pulmonary Hemorrhage
    and Nephritis 48 ANCA, 6 Anti GBM, 7 both, 27
    neither ANCA nor anti-GBM (latter group not
    many causes could explain both findings)

13
The End
14
References
  • Rose, Burton. Acute Glomerulonephritis and
    Pulmonary Hemorrhage, Course of
    Poststreptococcal Glomerulonephritis. Up To Date
    2005.
  • Harrisons Online. Glomerular Disease. Ch 264.
    2004-2005.
  • Niles JL, et al. The Syndrome of Lung Hemorrhage
    and Nephritis is Usually an ANCA Associated
    Condition. Arch Intern Med. 1996 156 440-445.
  • Gallagher H, et al. Pulmonary Renal Syndrome A
    4 Year, Single-Center Experience. Am J of Kidney
    Disease 2002 39 42-47.
  • Berrrios X, et al. Post-streptococcal Acute
    Glomerulonephritis in Chile 20 Years of
    Experience. Pediatr Nephrol 2004 19 306-312.
  • Johnson RJ, et al. Glomerular Disease Associated
    with Infection. Ch 30. Comprehensive Clinical
    Nephrology. 2000.
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