Most common Cp

AGN Acute poststreptococcal GN (APSGN) 1. Subclinical course (asymptomatic) C3 Hematuria Proteinuria Normal/ BP 2. Nephritic syndrome Dark colored urine (hematuria) Edema HTN Oliguria Mild/moderate proteinuria Renal impairement 3. Complications Acute renal failure (25%) Hyperkalemia Rapid progressive azotemia <0.5% Circulatory congestion (Lt.side HF) Hypertensive encephalopathy 1. Urine analysis Hematuria (RBC cast) 100% Mild/moderate proteinuria Mild normochromic anemia serum C3 level Evidence of recent strep.infection Rising ASO titer Anti DNase B level Renal biopsy Atypical presentation Infection, C3, ARF, NS, growth retardation, anemia Atypical resolution C3, kidney function, hematuria, proteinuria Renal function: serum creatinin

Investigation

2. 3. 4.

5.

6. DD

TTT

Red urine: 1. Macroscopic hematuria, myoglobinuria, hemoglobinuria 2. Pigments: bilirubin,urates,melanin 3. Inborn error of metabolism (AR) 4. Drugs: Chloroquine, metronidazole, rimfampin 5. Food/dyes 1. Bed rest & limited activity (RF & HF) 2. Salt & water restriction (hypovolemia) 3. Antibiotics Long acting Penicillin Oral Penicillin V macrolides

NEPHROTIC SYNDROME Minimal change disease (MCD) 1. Edema Major symptoms, 3-5% body weight Periorbital initial symptoms Gravity dependent LL Soft, pitting, anasarca ascites, pleural & pericardial effusion In scrotum & penis, or labie 2. Abdominal pain Ascites with hypovolemia peritonitis, thrombosis, pancreatitis 3. HTN 4. Macroscopic hematuria: 3% 5. Complications Infections Thromboembolism Hypovolemia Renal insufficiency (steroid resistant) Corticosteroid SE 6. Asymptomatic: rare 1. Urine analysis Nephrotic range proteinuria (dipstick) Micro: fat & hyaline cast Microscopic hematuria:20% 2. Blood test C3 & serum creatinine: Normal Serum albumin: <2.5 g/dL Total cholesterol & LDL: HDL: CBC: hemoconcentration (thrombosis) 3. Renal biopsy Macroscopic hematuria Persistent HTN C3 Persistent renal failure Failure to respond to corticosteroid Steroid dependent/resistent Generalized edema (malnutrition notes) 1. Nephrotic syndrome 2. Angioneurotic edema 3. Congestive heart failure 4. Liver cell failure

1.

2. 3.

Diet Salt & fluid restriction sat.fat,normal protein,CHO (starch) Hypovolemia: plasma or albumin HR, RR, BP Diuretics (after hypovolemic correction)

4. 5. 6. 7.

Edema : salt restriction & macrolides HTN: CCB, ACEIs, VDs Hyperkalemia: restrict K Immediate dialysis Severe hyperkalemia Azotemia Acidosis Uncontrolled HTN CVS insufficiency Pulmonary edema

Prognosis

-complete recovery >95% -recurrence: very rare

Furosemide 1-2mg/kg, Spironolactone 5-10mg/kg Severe edema: furosemide + albumin 20% (1g/kg) Refractory edema: drainage of ascites and/or pleural effusion 4. Thromboemboli: warfarin, low dose aspirin, dipyridamole 5. Infections: Strep.pneumonae: oral penicillin, pneumococcal vaccine Varicella: varicella immunity status, acyclovir, varicella vaccination 6. Hyperlipidemia: lowering regimen 7. Oral steroid (specific therapy) 2 Prednisone/Prednisolone 60mg/m /d (max), 20mg/kg/d for 4 months 8. TTT of relapse: steroid sparing agent Cyclophosphamide Cyclosporine 9. TTT of Steroid Resistant NS (SRNS) ACEIs & ARB immunosuppresive -SSNS : excellent -SRNS & MCD: later remission -about 50% of SRNS due to FSGS reach end stage renal disease in 7-10y

Generalized edema:
Nephrotic Syndrome -edema start in face -2-8y -heavy proteinuria & oliguria -hypoalbuminemia & hypercholesterolemia Angioneurotic Edema -edema more in eyelids & lips -ass. with urticarial wheals -itchingallergic Congestive Heart Failure -cardiac lesion -congestive neck vein, enlarged tender liver, edema LL -ascites Liver Cell Failure -jaundice, foetor hepaticus, flapping tremors -ascites -impaired liver function