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GLOMERULONEPRHITIS
DEFINITION
Clinical Spectrum and Outcome of Acute Post Streptococcal Glomerulonephritis in Children. 2017. Observational Study by MSHEid, Assiut University.
ETIOLOGY
• Nephritogenic strains of
group A Beta-hemolytic
streptococci
• Usually occurs
• 7-14 days after pharyngitis
• 2-6 weeks after skin
infection
Nelson Textbook of Pediatrics, 20th ed
GROUP A STREPTOCOCCUS
• Streptococcus pyogenes
• URTI, skin
• Scarlet fever, erysipelas
• TSS, necrotizing fasciitis
• Rheumatic fever, acute
glomerulonephritis
Nelson Textbook of Pediatrics, 20th ed
PATHOLOGY
• Gross: kidneys symmetrically
enlarged
• LM: enlarged, hypercellular
glomeruli
• IF: “lumpy-bumpy” deposits
• EM: dense deposits or
“humps:
PATHOGENESIS
Molecular mimicry
Complement activation
Nelson Textbook of Pediatrics, 20th ed
CLINICAL FEATURES
HEMATURIA
• Dark, smoky brown or cola-colored
• Glomerular: dysmorphic RBC, cast in freshly spun
urine
CLINICAL FEATURES
PROTEINURIA
• Mild to moderate but nephrotic range is rare
OLIGURIA
• Transient – 50%
* Anuria - rare
CLINICAL FEATURES
EDEMA - 85%
• Mild: periorbital or pedal
• Severe: hypertension, pleural effusion or ascites
• Adolescents: more likely face and legs
CLINICAL FEATURES
HYPERTENSION - 80%
• Headache, somnolence, changes in mental status
• Anorexia, nausea, convulsion
CLINICAL FEATURES
HYPERTENSIVE EMERGENCY - 10%
• BP > 30% increased for age and sex
• Evidence of encephalopathy
• Heart failure or pulmonary edema