1. POST INFECTIOUS GLOMERULONEPHRITIS (PIGN) Dr. Nariman Fahmi Ahmed Azat

2. Objectives Introduction (renal function) Definition (PIGN) pathogenesis Clinical Features Management Case Scenarios Discussion

3. Introduction The main functions of the kidneys are Controlling the balance of fluid and electrolytes Controlling acid base balance passing the waste products to bladder as urine controlling blood pressure

4. your kidneys. your kidneys. Each kidney contains one million nephrons. one million nephrons. nephrons Nephrons ( small structures that do the work ) Nephrons ( small structures that do the work )

5. Introduction the glomerulusglomerulus which is a tiny ball-shaped structure composed of blood vessels actively involved in the filtration of the blood to form urine. The tubules carries away filtered waste materials in the urine, and a small blood vessel returns filtered blood to the body( efferent arteriole)

6. Any disease of the kidney filters considered serious because it interferes with the basic functions of the kidneys.

7. PIGN * One of the oldest recognized renal diseases. Before named as :Acute poststreptococcal glomerulonephritis (APSGN) Currently :Post Infectious glomerulonephritis (PIGN)

8. Pathogeneic agents mainly group A streptococcus Nephritogenic strains M types 1,2, 4,12, 18, 25, 49, 55, 57, 60 ) (Nephritogenic strains M types 1,2, 4,12, 18, 25, 49, 55, 57, 60 ) Pathogeneic agent could also includes staph,gram negative bacteria,others

9. Pathogenesis glomerular-immune complex formation

10. antibodies find the target and complement destroys it. antibodies find the target and complement destroys it.

11. Post-Infectious GN The Infection does not occur in the kidneys, but in a different part of the body, such as the skin or throat.

12. This disorder may begin to develop one to two weeks after an untreated throat infection three to four weeks after an untreated skin infection. mostly common in children ages six to ten.

13. Clinical presentation: 3 phase sequence: infection - interval - nephritic syndrome The severity of renal involvement varies from asymptomatic microscopic hematuria with normal renal function to acute renal failure.

14. Richard Bright 1927 Acute Glomerulonephritis Abrupt onset Hematuria(coca couloured) Oliguria( Reduced GFR) Oedema (Salt and water retension) Hypertension

15. Periorbital swelling

16. DIAGNOSIS Urinalysis demonstrates Urinalysis demonstrates red blood cells (RBC) red blood cells (RBC) frequently in association with RBC casts frequently in association with RBC casts mild proteinuria, mild proteinuria, polymorphonuclear leukocytes polymorphonuclear leukocytes (Granular cast).

17. DIAGNOSIS A mild normochromic anemia. The serum C3 level is usually reduced in the acute phase and returns to normal 6–8 wk after onset positive throat culture report may support the diagnosis The antistreptolysin O titer is commonly elevated after a pharyngeal infection anti-deoxyribonuclease (DNase) B level after cutaneous infection.

18. Treatment Conservative management BP control (hypertension) Diuresis (oliguria,Oedema) Treatment of infection (throat or Skin)

19. Treatment Treatment is focused on relieving symptoms Restriction of salt and fluid Antibiotics (ex. Penicillin), for streptococcal bacteria. Blood pressure medications diuretic medications may be needed to control swelling and high blood pressure.

20. Dialysis ??

21. prognosis Usually mild disease recovery typically within weeks ( 95% )

22. Possible Complications Congestive heart failure pulmonary edema Hyperkalemia High blood pressure (hypertension) Acute renal failure Chronic glomerulonephritis

23. Acute Glomerulo Nephritis Case Scenarios 5 yr Girl Sudden onset Facial puffiness Oliguria & Cola colored urine Generalized oedema Headache Preceding infected skin lesion following trauma No other specific features Physical Examination – Generalized Oedema, Hypertension

24. On Evaluation : Urine coke colored 1-2 + proteinuria Red blood cells, red cell and granular casts normal B. Urea 68-102-145mgm/dl S. Creatinine 0.8—1.6—3-4 mgm/dl S.Sodium / Potassium 128/5.8—132/6.4meq/L ASO Positive Serum Complement C3 – 0.3 mgm/dl (0.9- 1.2 mgm/dl)

25. How do you manage this patient?? What is the possible complications in this case??

26. Thank you

27. References http://www.umm.edu/ency/article/000471.htm http://www.fpnotebook.com/REN38.htm http://www.paems.org/eWebquiz/renal%20failure/Dialysis%20CEU.pdf http://www.loyolaems.com/sop/4med.htm#med8 http://www.chpnet.org/BIEM_Res/lectures.asp http://www.emedicine.com/emerg/topic501.htm http://g.msn.com/9SE/1?http://www.irishhealth.com/index.html?level=4&id =538&&DI=293&IG=6f0f1fd0f6854d928d14d6e96915e742&POS=22&CM= IMG&CE=22&CS=AWP&SR=22http://g.msn.com/9SE/1?http://www.irishhealth.com/index.html?level=4&id =538&&DI=293&IG=6f0f1fd0f6854d928d14d6e96915e742&POS=22&CM= IMG&CE=22&CS=AWP&SR=22 http://http://www.medonline.com.br/med_ed/med1/iranejm.htmhttp://http://www.medonline.com.br/med_ed/med1/iranejm.htm www.auburn.edu/~deruija/renal_part3/sld001.htm file:///C:/Documents%20and%20Settings/Wendy/Local%20Settings/Tempo rary%20Internet%20Files/Content.IE5/FBZ7VWDX/12.03.03-DrSturmann- Acute%26ChronicRenalFailure%5B1%5D.ppt#256,1,RENAL FAILURE file:///C:/Documents%20and%20Settings/Wendy/Local%20Settings/Tempo rary%20Internet%20Files/Content.IE5/AQVFLSNN/CHRONICRENALFAIL UREANDHEMODIALYSIS%5B1%5D.ppt#311,2,CHRONIC RENAL FAILURE