Glomerular Diseases

Posted by e-Medical PPT Saturday, October 22, 2011
Major Clinical Manifestations of Glomerular Diseases
Acute nephritic syndrome
The nephrotic syndrome
Persistent urinary abnormalities with few or no symptoms
Chronic glomerulonephritis

Clinical Features of the Acute Nephritic Syndrome
haematuria is usually macroscopic with pink or brown urine (like coca cola)
oliguria may be overlooked or absent in milder cases
oedema is usually mild and is often just peri-orbital- weight gain may be detected
hypertension common and associated with raised urea and creatinine
proteinuria is variable but usually less than in the nephrotic syndrome

Aetiology of the Nephritic Syndrome
Most common cause is acute post infectious glomerulonephritis
group A beta haemolytic streptococci of certain serotypes important in NZ
IgA disease and Henoch-Schonlein purpura,  crescentic glomerulonephritis and  SLE can also present in this way

Management issues in the nephritic syndrome
Appropriate investigations: skin and throat swabs,strep serology, complement, urea, creatinine electrolytes, urinalysis and CXR
BP, urine output and daily weight
fluid and diet management
treat hypertension and fluid overload
treat infection

Complications of the Nephritic Syndrome
Hypertensive encephalopathy (seizures, coma)
Heart Failure (pulmonary oedema)
Uraemia requiring dialysis

Prognosis in the Nephritic Syndrome
More than 95% of children make a complete recovery
Chronic renal impairment in the longer term is uncommon in children
Bad prognostic features include severe renal impairment at presentation and continuing heavy proteinuria and hypertension
Adults more likely to have long term sequellae than children

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