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Third Year Medical Student
MARA University of Technology, Malaysia

(this is the edited slides, after discussions with Assoc. Prof. Dr. Rashid =)
and bedsite teaching with Dr Faisal =)

£ Synonyms: acute nephritis,
acute nephritic syndrome

£ An immunologic mechanism (Type III hypersensitivity)


resulted from an immune process that injures the
glomeruli of the kidney, leading to reduced renal
function characterized as follows:

£ linical features:
² A sudden onset of hematuria,
² Proteinuria,
² Edema,
² Oliguria and volume overload,
² Hypertension,
² Azotemia is another common but inconstant finding.
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(side note)
£ Treatment of Hyperkalemia
1. Insulin + glucose (will cause
transcellular shift of K+ into the cell)
2. Sodium bicarbonate
3. alcium gluconate (as a cardioprotective
agent.Though it does not have an effect on potassium levels
in the blood, it reduces the excitability of cardiomyocytes
thus lowering the likelihood of developing cardiac
arrhythmias.)²
IV slow infusion
4. helating agent
5. Lastly, consider dialysis (peritoneal
dialysis in children)
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Points to support Points against
Membrano- a) Nephritic syndrome a) Persistent nephritic syndrome
proliferative b) Elevated ASO titer b) Hypocomplementemia ( 3) - >6-8w
GN c) Hypocomplement- c) Marked reduced renal fn.
emia d) Dx ² by renal biopsy ² ´tram-
trackingµ GBM
IgA a) Hematuria a) Recurrent
nephropathy b) Associated with b) No period of latency
(Berger·s respiratory illness c) Hypertension & edema ² uncommon
disease) (following viral d) ASO ² not elevated
syndromes) e) ȸ Serum IgA (15%)
f) Normal serum complement values
g) Focal proliferation, diffuse
mesangial IgA deposits
Henoch- a) Hematuria (80%) a) haracteristic skin rash
Schönlein b) Mild proteinuria b) Assoc. symptoms: Abdominal pain,
Purpura c) Preceding by URTI diarrhea (due to intussusceptions),
(only 50%) athritis, athralgia
c) Normal serum complement values
!!#  #"
Points to support Points against
Familial a) Nephritic syndrome      
 

nephritis b) 1-2 days following URTI 

(Alport b) Progressive proteinuria after 2nd
Syndrome) decade of life
c) Association with non-renal
manifestations: hearing deficits &
ocular abnormalities
SLE a) Occurs in 30²70% of      
 

nephritis children 

(Nephritic- b) Hematuria b) Association with non-renal
Grade I & II, c) Mild proteinuria manifestations
Nephrotic- d) Hypocomplement-emia c) 4 also depressed.
Grade III)
( 3) d) Detection of anti-nuclear antibodies.
Other a) Acute nephritic  !       
chronic syndrome 

    

infections: b) Similar histopathologic b) Treatment is unresponsive
findings
c) Hypocomplementemia
wAdditional notes after bedsite with dr faisal


 
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£ Treatment of APSGN is largely that of
supportive care.
£ Usually, patients undergo a
spontaneous diuresis within 7 to 10
days after the onset of their illness -
strict monitoring ² nephrotic chart +
fluid restriction until diuresis
£ Management is directed at treating the
acute effects of renal insufficiency and
hypertension
£ Diuretics  
 

£ Diet
Fluid restriction² during oliguric phase
Sodium restriction is necessary
Protein restriction is unnecessary

£ Antibiotics
  
 
  +
A 10-day course of systemic antibiotic therapy with
*  ,    penicillin V is recommended to limit the spread of the
    nephritogenic organisms.
   
  
Antibiotic therapy does not affect the natural history of
       glomerulonephritis.

  
  
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symptomatic, severe hypertension or hypertensive emergency / encephalopathy

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