Acute proliferative glomerulonephritis

Acute proliferative glomerulonephritis
Classification and external resources
ICD-9	580.0
DiseasesDB	29306
MedlinePlus	000503
eMedicine	med/889

In nephrology, acute proliferative glomerulonephritis is a disorder of the glomeruli (glomerulonephritis), or small blood vessels in the kidneys. It is a common complication of infections, typically streptococcal pharyngitis, for which it is also known as postinfectious or poststreptococcal glomerulnephritis.

It can be a risk factor for future albuminuria.^[1]

Contents 1 Causes 2 Pathophysiology 3 Diagnosis 3.1 Presentation 3.1.1 Mechanism of edema 3.2 Differential diagnosis 4 References 5 External links

Causes

Acute proliferative glomerulonephritis can be a complication of streptococcal pharyngitis (strep throat) and impetigo.

Pathophysiology

The exact pathology remains unclear, but it is believed to be type III hypersensitivity reaction. Immune complexes (antigen-antibody complexes formed during an infection) become lodged in the glomerular basement membrane. Complement activation leads to destruction of the basement membrane. It has also been proposed that specific antigens from certain nephrotoxic streptococcal infections have a high affinity for basement membrane proteins, giving rise to particularly severe, long lasting antibody response.

Diagnosis

Diagnosis rarely requires a renal biopsy since there is usually a classical clinical presentation. There will be elevated levels of ASOT Ab and low complement levels in the blood.

Presentation

1) Hematuria:^[2]

• May be microscopic and not identified by the patient.

• May be macroscopic and lead to dark brown or smoky urine.

• Frank hematuria may occur in severe case.

2) Oliguria

• Urine output is less than 400 ml/day (normally 600 to 2500 ml/day).

• May be not observed by the patient.

3) Edema

• Acute onset.

• Mild to modest severity.

• Pitting edema.

• Starts in the eye lids and face then the lower and upper limbs then generalized (Hydrocele, ascites. Pericardial and pleural effusion.)

• It may be migratory: appear in eyelid in the morning, disappear in the afternoon and reappear around the ankle in the ambulant patients by the end of the day.

4) Hypertension.

• It is usually mild to moderate.

• Hypertensive encephalopathy, heart failure and acute pulmonary edema may occur in severe cases.

• Pulmonary congestion and congested neck veins may be present, but usually due to salt and water retention and less commonly heart failure.

5) General

• Fever, headache, malaise, anorexia, nausea and vomiting.

• Pallor due to edema and/or anemia.

6) Acute renal necrosis due to injury of capillary or capillary thrombosis.

• Acute tubular obstruction by cast.

Mechanism of edema

A) Decreased glomerular permeability

B) Secondary hyperaldosteronism

C) Hypoalbuminemia

Differential diagnosis

1. Other causes of acute glomerulonephritis:
   • Lupus nephritis
   • Type 1 membranoproliferative glomerulonephritis
   • Bacterial endocarditis
   • Shunt nephritis
   • Cryoglobulinemia
2. Nephrotic syndrome
3. Other causes of generalized edema:
   • Malnutrition
   • Malabsorption
   • Renal affection
   • Liver cell failure
   • Right side heart failure
   • Angioedema
4. Other causes of hematuria

References

External links

• Post-infectious glomerulonephritis - Mayo Clinic
• Group A Streptococcal Infections - National Institute of Allergy and Infectious Diseases

v • d • e Urinary system · Pathology · Urologic disease / Uropathy (N00-N39, 580-599) Abdominal Nephropathy/ (nephritis+ nephrosis) Glomerulopathy/ glomerulitis/ (glomerulonephritis+ glomerulonephrosis) Primarily nephrotic Non-proliferative .0 Minimal change · .1 Focal segmental · .2 Membranous Proliferative .3 Mesangial proliferative · .4 Endocapillary proliferative .5/.6 Membranoproliferative/mesangiocapillary By condition Diabetic · Amyloidosis Primarily nephritic, .7 RPG Type I RPG/Type II hypersensitivity Goodpasture's syndrome Type II RPG/Type III hypersensitivity Post-streptococcal · Lupus (DPN) · IgA/Berger's Type III RPG/Pauci-immune Wegener's granulomatosis · Microscopic polyangiitis Tubulopathy/ tubulitis Proximal RTA (RTA 2) Thick ascending Bartter syndrome Distal convoluted Gitelman syndrome Collecting duct Liddle's syndrome · RTA (RTA 1) · Diabetes insipidus (Nephrogenic) Renal papilla Renal papillary necrosis Major calyx/pelvis Hydronephrosis · Pyonephrosis · Reflux nephropathy Any/all Acute tubular necrosis Interstitium Interstitial nephritis (Pyelonephritis, Danubian endemic familial nephropathy) Any/all General syndromes Renal failure (Acute renal failure, Chronic renal failure) · Uremic pericarditis · Uremia Vascular Renal artery stenosis · Hypertensive nephropathy · Renovascular hypertension Other Analgesic nephropathy · Renal osteodystrophy · Nephroptosis · Abderhalden-Kaufmann-Lignac syndrome Ureter Ureteritis · Ureterocele · Megaureter Pelvic Bladder Cystitis (Interstitial cystitis/painful bladder syndrome, Hunner's ulcer, Trigonitis, Hemorrhagic cystitis) · Neurogenic bladder · Vesicointestinal fistula · Vesicoureteral reflux Urethra Urethritis (Non-gonococcal urethritis) · Urethral syndrome · Urethral stricture Any/all Obstructive uropathy · Urinary tract infection · Retroperitoneal fibrosis · Urolithiasis (Kidney stone, Renal colic) · Malacoplakia See also congenital, neoplasia, symptoms/signs

v • d • e Immune disorders: hypersensitivity and autoimmune diseases Type I/allergy/atopy (IgE) Foreign Atopic dermatitis · Allergic urticaria · Hay fever · Allergic asthma · Anaphylaxis · Food allergy (Milk, Egg, Peanut, Tree nut, Seafood, Soy, Wheat) Autoimmune none Type II/ADCC (IgM, IgG) Foreign Pernicious anemia · Hemolytic disease of the newborn · Penicillin allergy Autoimmune Cytotoxic Autoimmune hemolytic anemia · Idiopathic thrombocytopenic purpura  · Bullous pemphigoid  · Pemphigus vulgaris · Rheumatic fever · Goodpasture's syndrome "Type 5"/receptor Graves' disease · Myasthenia gravis Type III (Immune complex) Foreign Henoch-Schönlein purpura · Hypersensitivity vasculitis · Reactive arthritis · Rheumatoid arthritis · Farmer's lung · Post-streptococcal glomerulonephritis · Serum sickness · Arthus reaction Autoimmune Systemic lupus erythematosus · Subacute bacterial endocarditis Type IV/cell-mediated (T-cells) Foreign Contact dermatitis · Mantoux test Autoimmune Diabetes mellitus type 1 · Hashimoto's thyroiditis · Guillain-Barré syndrome  · Multiple sclerosis  · Coeliac disease · Giant cell arteritis GVHD Transfusion-associated graft versus host disease Unknown/ multiple Foreign Hypersensitivity pneumonitis (Allergic bronchopulmonary aspergillosis) · Transplant rejection · Latex allergy (I+IV) Autoimmune Sjögren's syndrome · Autoimmune hepatitis · Autoimmune polyendocrine syndrome (APS1, APS2) · Autoimmune adrenalitis

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