Acute Glomerulonephritis Flashcards
What is acute glomerulonephritis?
Inflammation of the glomeruli.
sudden onset
causes: infections (strep throat) or other underlying diseases (lupus, Goodpasture’s syndrome, Wegner’s disease, and polyarteritis nodosa)
- specific set of kidney diseases
- in which immunological mechanisms trigger inflammation and proliferation of glomerular tissue that can result in damage to the basement membrane, mesangium, or capillary endothelium.
What is the pathophysiology of acute glomerulonephritis (GN)?
- Glomerular lesions are the result of glomerular deposition or in situ formation of immune complexes
- Kidneys may be enlarged up to 50%
- in PSGN (streptococcal glomerulonephritis), streptococcal neuraminidase may alter host immunoglobulin G (IgG). IgG combines with host antibodies. IgG/anti-IgG immune complexes form and then collect in the glomeruli.
What are structural and functional changes in the pathophysiology of acute glomerulonephritis (GN)?
- Structure: cellular proliferation leads to an increase in the number of cells in the glomerular tuft - a proliferation of endothelial, mesangial, and epithelial cells.
- Proliferation may be endocapillary or extra capillary
- endocapillary (ie, within the confines of the glomerular capillary tufts) or extra capillary (ie, in the Bowman space involving the epithelial cells).
- In extracapillary proliferation, proliferation of parietal epithelial cells leads to the formation of crescents, a feature characteristic of certain forms of rapidly progressive glomerulonephritis.
- leukocyte proliferation may accompany cellular proliferation - neutrophils and macrophages
- Glomerular basement membrane thickening
- Hyalinization or sclerosis indicates irreversible damage
- structural changes can be diffuse, focal, or segmental, or global.
- Functional: proteinuria, hematuria, reduction of GFR (oliguria, anuria), active urine sediment with RBCs and RBC casts.
- The decreased GFR and avid distal nephron salt and water retention result in expansion of intravascular volume, edema, and, frequently, systemic hypertension.
What is the pathophysiology of poststreptococcal glomerulonephritis (GN)?
-
How are the causes of acute glomerulonephritis (GN) categorized?
infectious and non-infectious causes
What are the infectious causes of acute glomerulonephritis (GN)?
- most common: Streptococcus species - group A, beta-hemolytic
- 2 serotypes - serotype 12 & 49
- PSGN usually develops 1-3 weeks after acute
- PSGN usually develops 1-3 weeks after acute infection with specific nephritogenic strains of group A beta-hemolytic streptococcus.
- Non streptococcal infection -
postinfectious glomerulonephritis may also result from infection by other bacteria, viruses, parasites, or fungi. Bacteria other than group A streptococci that can cause AGN include the following:
Staphylococci
Diplococci
Other streptococci
Mycobacteria
Salmonella typhosa
Brucella suis
Treponema pallidum
Corynebacterium bovis
Actinobacilli
Which bacteria cause nonstreptococcal postinfectious glomerulonephritis (GN)?
Staphylococci
Diplococci
Other streptococci
Mycobacteria
Salmonella typhosa
Brucella suis
Treponema pallidum
Corynebacterium bovis
Actinobacilli
What are the viral causes of acute glomerulonephritis (GN)?
Cytomegalovirus (CMV), coxsackievirus, Epstein-Barr virus (EBV), hepatitis B virus (HBV), [11] rubella, rickettsiae (as in scrub typhus), parvovirus B19, [12] and mumps virus are accepted as viral causes only if it can be documented that a recent group A beta-hemolytic streptococcal infection did not occur.
AGN has been documented as a rare complication of hepatitis A.
What are the noninfectious causes of acute glomerulonephritis (GN)?
Attributing glomerulonephritis to a parasitic or fungal etiology also requires the exclusion of a streptococcal infection. Identified organisms include Coccidioides immitis and the following parasites:
Plasmodium malariae
Plasmodium falciparum
Schistosoma mansoni
Toxoplasma gondii
Wuchereria bancrofti
Trichinella roundworms
Trypanosomes
What the multisystem systemic diseases that cause acute glomerulonephritis (GN)?
- Vasculitis
- Collagen-vascular diseases - systemic lupus erythematous
- Hypersensitivity vasculitis
- Cryoglobulinemia
- Polyarteritis nodosa
- Henoch-Schönlein purpura - This causes a generalized vasculitis resulting in glomerulonephritis.
- Goodpasture syndrome - This causes circulating antibodies to type IV collagen and often results in a rapidly progressive oliguric renal failure (weeks to months).
What are the primary renal diseases that cause acute glomerulonephritis (GN)?
- Membranoproliferative glomerulonephritis
- Immunoglobulin A (IgA) nephropathy
- “Pure” mesangial proliferative glomerulonephritis
- ## Idiopathic rapidly progressive glomerulonephritis
What are the miscellaneous noninfectious causes of acute glomerulonephritis (GN)?
Miscellaneous noninfectious causes of acute GN include the following:
Guillain-Barré syndrome
Irradiation of Wilms tumor
Diphtheria-pertussis-tetanus (DPT) vaccine
Serum sickness
Epidermal growth factor receptor activation, [14] and possibly its inhibition by cetuximab [15]
COVID-19 vaccine
What is the global prevalence of acute glomerulonephritis (GN)?
Worldwide, IgA nephropathy (Berger disease) is the most common cause of glomerulonephritis.
Which patient groups have the highest prevalence of acute glomerulonephritis (GN)?
AGN predominantly affects males (2:1 male-to-female ratio).
Postinfectious GN has no predilection for any racial or ethnic group.
A higher incidence (related to poor hygiene) may be observed in some socioeconomic groups.
What is the prognosis of acute glomerulonephritis (GN)?
- Most epidemic cases follow a course ending in complete patient recovery (as many as 100%).
- Sporadic cases of acute nephritis often progress to a chronic form.
- Proteinuria may persist for 6 months and microscopic hematuria for up to 1 year after onset of nephritis.
- Eventually, all urinary abnormalities should disappear, hypertension should subside, and kidney function should return to normal.
What is included in patient education about acute glomerulonephritis (GN)?
Counsel patients about the need for the following measures:
Salt restriction during the acute phase to control edema and volume-related hypertension
Blood pressure monitoring at periodic intervals
Ongoing long-term monitoring of patients with persistent urinary abnormalities and elevated blood pressure
Consideration of protein restriction and angiotensin-converting enzyme (ACE) inhibitors (in patients who show evidence of persistent abnormalities or in those who develop late evidence of progressive disease)
Early antibiotic treatment of close contacts
Which clinical history findings are characteristic of acute glomerulonephritis (GN)?
- most common presentation:
- male
- 2-14 years
- puffiness of teh eyelids
- facial edema
- postrep infection
dark, scanty urine - elevated bp
- nonspecific symptoms - weakness, fever, abdominal pain, and malaise
ask patient:
- onset
- duration
What are the signs and symptoms of acute glomerulonephritis (GN)?
- hematuria
- oliguria
- edema (peripheral or periorbital)
- headache
- SOB or dyspnoea
- possible flank pain
Rash (as with vasculitis, Henoch-Schönlein purpura, or lupus nephritis)
Pallor
Renal angle (ie, costovertebral) fullness or tenderness, joint swelling, or tenderness
Hematuria, either macroscopic (gross) or microscopic
Abnormal neurologic examination or altered level of consciousness (from malignant hypertension or hypertensive encephalopathy)
Arthritis
other signs to look for:
Pharyngitis
Impetigo
Respiratory infection
Pulmonary hemorrhage
Heart murmur (possibly indicative of endocarditis)
Scarlet fever
Weight gain
Abdominal pain
Anorexia
Back pain
Oral ulcers
What are the classic presentations of acute glomerulonephritis (GN)?
Patients often have a normal physical examination and blood pressure; most frequently, however, patients present with a combination of edema, hypertension, and oliguria.
What are signs of fluid overload in acute glomerulonephritis (GN)?
signs of fluid overload:
Periorbital and/or pedal edema
Edema and hypertension due to fluid overload (in 75% of patients)
Crackles (ie, if pulmonary edema)
Elevated jugular venous pressure
Ascites and pleural effusion (possible)
What are the physical signs of acute glomerulonephritis (GN)?
Glomerulonephritis signs and symptoms may include:
Pink or cola-colored urine from red blood cells in your urine (hematuria)
Foamy or bubbly urine due to excess protein in the urine (proteinuria)
High blood pressure (hypertension)
Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen
Urinating less than usual
Nausea and vomiting
Muscle cramps
Fatigue
What are the possible complications of acute glomerulonephritis (GN)?
Glomerulonephritis affects the ability of nephrons to filter the bloodstream efficiently. The breakdown in filtering results in:
Accumulation of wastes or toxins in the bloodstream
Poor regulation of essential minerals and nutrients
Loss of red blood cells
Loss of blood proteins
possible complications:
- acute kidney failure - sudden, rapid decline in kidney function, accumulation of waste products
- chronic kidney disease - kidney damage or decreased function for three + months
- High BP - damage to glomeruli from inflammation and scarring can lead to high BP
- nephrotic syndrome - too much blood protein in urine and too little in the bloodstream.
Which renal syndromes are included in the differential diagnoses of early stage acute glomerulonephritis (GN)?
The following four renal syndromes commonly mimic the early stage of acute glomerulonephritis (AGN):
Anaphylactoid purpura with nephritis
Chronic glomerulonephritis with an acute exacerbation
Idiopathic hematuria
Familial nephritis
What conditions are included in the differential diagnoses of postinfectious glomerulonephritis (GN)?
Postinfectious glomerulonephritis must be differentiated from the following conditions:
- Immunoglobulin A (IgA) nephritis
- Membranoproliferative glomerulonephritis (MPGN), types I and II
- Lupus nephritis
- Glomerulonephritis of chronic infection
- Vasculitis
- Predominantly nonglomerular diseases - Thrombotic thrombocytopenic purpura (TTP), hemolytic-uremic syndrome (HUS), atheroembolic renal disease, and acute hypersensitivity interstitial nephritis may present with features of acute nephritic syndrome and should be differentiated
What are the differential diagnoses for Acute Glomerulonephritis?
Acute Kidney Injury (AKI)
Crescentic Glomerulonephritis
Diffuse Proliferative Glomerulonephritis
Focal Segmental Glomerulosclerosis
Glomerulonephritis Associated with Nonstreptococcal Infection
Goodpasture Syndrome
Lupus Nephritis
Membranoproliferative Glomerulonephritis
Poststreptococcal Glomerulonephritis
Rapidly Progressive Glomerulonephritis
Which tests are performed in the workup of acute glomerulonephritis (GN)?
- blood tests
- complement levels
- urinalysis and 24-hour urine study
- strptoenzyme test
- blood and tissue culture
- otehr laboratory tests
- radiography and CT
- US and echocardiography
- kidney biopsy
- histology
What is the role of blood tests in the workup of acute glomerulonephritis (GN)?
Blood tests should include the following:
Complete blood count (CBC)
Blood urea nitrogen (BUN), serum creatinine, and serum electrolytes (especially serum potassium)
Erythrocyte sedimentation rate (ESR)
Complement levels (C3, C4, CH50)
What is the role of serum complement measurement in the workup of acute glomerulonephritis (GN)?
- ## help to narrow the DDx
What is the role of urinalysis and 24-hour urine study in the workup of acute glomerulonephritis (GN)?
What is the role of a streptozyme test in the workup of acute glomerulonephritis (GN)?
What is the role of a blood tissue culture in the workup of acute glomerulonephritis (GN)?
What is the role of antibody tests in the workup of acute glomerulonephritis (GN)?
Which lab tests are indicated in the workup of acute glomerulonephritis (GN)?
What is the role of radiography in the workup of acute glomerulonephritis (GN)?
What is the role of CT scanning in the workup of acute glomerulonephritis (GN)?
What is the role of ultrasonography in the workup of acute glomerulonephritis (GN)?
What is the role of echocardiography in the workup of acute glomerulonephritis (GN)?
What is the role of kidney biopsy in the workup of acute glomerulonephritis (GN)?
Which histologic findings are characteristic of acute glomerulonephritis (GN)?
How is acute glomerulonephritis (GN) treated?
Which medications are used in the treatment of acute glomerulonephritis (GN)?
Which dietary and activity modifications are used in the treatment of acute glomerulonephritis (GN)?
What is included in the long-term monitoring of acute glomerulonephritis (GN)?
What is the goal of drug treatment for acute glomerulonephritis (GN)?
Which medications in the drug class Calcium Channel Blockers are used in the treatment of Acute Glomerulonephritis?
Which medications in the drug class Vasodilators are used in the treatment of Acute Glomerulonephritis?
Which medications in the drug class Loop Diuretics are used in the treatment of Acute Glomerulonephritis?
Which medications in the drug class Antimicrobials (Antibiotics) are used in the treatment of Acute Glomerulonephritis?
