see also: [[Acute Renal Failure|AKI]], [[Henoch-Schonlein Purpura|HSP]] [Cameron paeds AKI](x-devonthink-item://A07F62D2-8A92-41CF-AF4B-0A257E26E8DA?page=1), [tintinalli renal emergencies in children](x-devonthink-item://0F9460DB-B25C-49C8-8ABE-9AB6E3B12F79?page=113), [Rosen post-strep glomerulonephritis](x-devonthink-item://0DB37919-FBA0-4F27-B75D-7BCB66044943?page=10) ![[Pasted image 20240724201320.png]] # Post-Strep Glomerulonephritis #paeds - follows pharyngeal or skin infection with group A beta haemolytic strep - can also get from subacute bacterial [[Endocarditis]] or VP shunt infections, chronic suppuration - 6-21 days latent period - *immune complex-mediated* disease → granular deposits of IgG on capillary basement membrane and in mesangial regions **clinical features** - abrupt onset - smoky, rust-coloured urine - ==hypertension== - ==oedema== especially facial / periorbital **Ix** - urinalysis -- RBCs, WBCs, and urinary casts - mild normochromic [[Anaemia]] - [[hyperkalemia]] - ↑ ESR - ASO titre rises **Treatment** - mostly supportive - tx hyperkalema or fluid overload as needed - calcium channel blockers eg nifedipine or amlodipine - Frusemide only for fluid overload (not oliguria) 2-4mg/kg max 40mg - abx treatment of strep infections does NOT alter incidence - fluid and salt restriction **prognosis** - usually self-limiting - 95% recover normal renal f(x) in <2 months - 5% develop rapidly progressive glomerulonephritis # IgA nephropathy - most common cause of acute glomerulonephritis - cause unknown - *Berger's disease* if isolated to kidney - same renal lesion as in [[Henoch-Schonlein Purpura|HSP]] **assessment** - macroscopic haematuria -- lasts 2-6 days - concominant URTI in 50% - gastro sx in 10% - unlikely to have HTN or oedema - usually proteinuria < 1-2 g/day - 10% have nephrotic syndrome **management** - tx HTN - steroids / cyclophosphamide may be considered if proteinuria persists despite BP control **prognosis** - 50% w/ gross haematuria have single episode - 50% recurrent episodes over years - 50% of these eventually lose renal function - prognosis worse in adults than children - proteinuria >3g/day poor prognostic sign, as is early HTN # Rapidly progressive GN - any glomerular disease a/w rapid loss of renal f(x) - acute GN often has transient oliguria followed by diuresis - some have rapid progression to renal failure - HTN, oedema, proteinuria, haematuria, RBC casts causes: - immune complex disease (40%) - SLE - cryoglobulinaemia - post-infectious - membranoproliferative GN - pauci-immune crescenting glomerulonephritis - 80% have ANCA - anti-glomeruloar basement membrane GN - goodpasture's syndrome **Ix** - *renal bx important* - causes categorised according to immunofluresence patterns found on biopsy **management** - salt and H2O restriction - antihpertensive therapy - +/- [[haemodialysis|dialysis]] - # Goodpasture's syndrome - rapidly progressive renal insufficency in pt with haemoptysis - possibly linked ot influenza - mostly young white male smokers - due to anti-GM antibody **assessment** - pulmonary haemorrhage - pulm sx usually appear first - Fe def anaemia -- secondary to blood loss and Fe sequestration in lungs - glomerulonephritis - renal disease usually <2 weeks after pulm disease **mgmt** - plasmapheresis to remove circulating anti-GBM antibody - prednisolone 1mg/kg/day - cyclophosphamide 2-3 mg/kg/day or azathioprine 1-2mg/kg/day # Related questions ## glomerulonephritis - [ ] 16Q: [Paediatric Haematuria](x-devonthink-item://B9F58929-18E6-4557-B393-263A6C98DFEF?page=4) -- [Answer](x-devonthink-item://DE4A2FC7-79D2-4B5D-805E-E481F1189654?page=3)