| Acute proliferative glomerulonephritis |
| Classification and external resources |
Micrograph of a post-infectious glomerulonephritis. Kidney biopsy. PAS stain.
|
| ICD-9 |
580.0 |
| DiseasesDB |
29306 |
| MedlinePlus |
000503 |
| eMedicine |
med/889 |
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 skin infection (impetigo) rather than streptococcal pharyngitis, for which it is also known as postinfectious or poststreptococcal glomerulonephritis.[1]
It can be a risk factor for future albuminuria.[2]
Contents
- 1 Signs and symptoms
- 2 Causes
- 3 Pathophysiology
- 4 Diagnosis
- 4.1 Mechanism of edema
- 4.2 Differential diagnosis
- 5 Complications
- 6 Epidemiology
- 7 References
- 8 External links
Signs and symptoms[edit]
Hematuria:[3]
- 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.
Oliguria
- Urine output is less than 400 ml/day (normally 600 to 2500 ml/day). In children it is less than 0.5 mL/ kg/ hr.
- May not be observed by the patient.
Edema
- Acute onset.
- Mild to modest severity.
- Pitting edema.
- Starts in the eyelids and face then the lower and upper limbs then generalized (e.g. hydrocele, ascites.pericardial and pleural effusion.)
- It may be migratory: appearing in eyelid in the morning, disappearing in the afternoon, and reappearing around the ankle in ambulatory patients by the end of the day.
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 is usually due to salt and water retention (and, less commonly, heart failure).
General
- Fever, headache, malaise, anorexia, nausea, and vomiting.
- Pallor due to edema and/or anemia.
Acute renal necrosis due to injury of capillary or capillary thrombosis. Acute tubular obstruction by cast.
Causes[edit]
Acute proliferative glomerulonephritis can be a complication of streptococcal pharyngitis (strep throat) and impetigo.
Pathophysiology[edit]
Schematic representation.
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 below the podocyte foot processes. This creates a lumpy bumpy appearance on light microscopy and subepithelial humps on electron microscopy. 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[edit]
Diagnosis rarely requires a renal biopsy since there is usually a classical clinical presentation. There will be an elevated Anti-streptolysin O titre and low complement levels (C3 and C4) in the blood.
Mechanism of edema[edit]
Diffuse Proliferative Glomerulonephritis (DPGN) is a nephritic syndrome; therefore, it causes edema through an increase in hydrostatic pressure and fluid overload secondary to inflammatory damage. Examples of nephritic syndrome include: DPGN, IgA nephropathy, lupus nephritis, and MPGN.
Hypoalbuminemia is the cause of edema in nephrotic syndrome (characterized by heavy proteinuria—greater than 3.5g/day). Examples include: minimal change disease (MCD), membranous glomerulonephritis (MGN), focal segmental glomerulosclerosis (FSGS), lupus, amyloidosis, and diabetes.
Differential diagnosis[edit]
- Other causes of acute glomerulonephritis:
- IgA Nephropathy
- Lupus nephritis
- Type 1 membranoproliferative glomerulonephritis
- Bacterial endocarditis
- Shunt nephritis
- Cryoglobulinemia
- Nephrotic syndrome
- Other causes of generalized edema:
- Malnutrition
- Malabsorption
- Renal affection
- Liver cell failure
- Right side heart failure
- Angioedema
- Other causes of hematuria
Complications[edit]
Possible complications of acute proliferative glomerulonephritis include renal failure and hypertensive encephalopathy.
Epidemiology[edit]
Acute glomerulonephritis resulted in about 84,000 deaths in 2010 down from 135,000 in 1990.[4]
References[edit]
- ^ Baltimore RS (February 2010). "Re-evaluation of antibiotic treatment of streptococcal pharyngitis". Curr. Opin. Pediatr. 22 (1): 77–82. doi:10.1097/MOP.0b013e32833502e7. PMID 19996970.
- ^ White AV, Hoy WE, McCredie DA (May 2001). "Childhood post-streptococcal glomerulonephritis as a risk factor for chronic renal disease in later life". Med. J. Aust. 174 (10): 492–6. PMID 11419767.
- ^ Sung HY, Lim CH, Shin MJ, et al. (December 2007). "A case of post-streptococcal glomerulonephritis with diffuse alveolar hemorrhage". J. Korean Med. Sci. 22 (6): 1074–8. doi:10.3346/jkms.2007.22.6.1074. PMID 18162726.
- ^ Lozano, R (2012 Dec 15). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.". Lancet 380 (9859): 2095–128. PMID 23245604.
External links[edit]
- Post-infectious glomerulonephritis - Mayo Clinic
- Group A Streptococcal Infections - National Institute of Allergy and Infectious Diseases
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Urinary system · Pathology · Urologic disease / Uropathy (N00–N39, 580–599)
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| Abdominal |
Nephropathy/
(nephritis+
nephrosis) |
Glomerulopathy/
glomerulitis/
(glomerulonephritis+
glomerulonephrosis) |
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Primarily
nephrotic
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Non-proliferative
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Minimal change · Focal segmental · Membranous
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Proliferative
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Mesangial proliferative · Endocapillary proliferative · Membranoproliferative/mesangiocapillary
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By condition
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Diabetic · Amyloidosis
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Type I RPG/Type II hypersensitivity
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Goodpasture's syndrome
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Type II RPG/Type III hypersensitivity
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Post-streptococcal · Lupus (DPN) · IgA/Berger's
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Type III RPG/Pauci-immune
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Granulomatosis with polyangiitis (Wegener's) · Microscopic polyangiitis · Churg-Strauss Syndrome
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Tubulopathy/
tubulitis
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Proximal
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RTA (RTA 2) · Fanconi syndrome
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Thick ascending
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Bartter syndrome
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Distal convoluted
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Gitelman syndrome
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Collecting duct
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Liddle's syndrome · RTA (RTA 1) · Diabetes insipidus (Nephrogenic)
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Renal papilla
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Renal papillary necrosis
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Major calyx/pelvis
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Hydronephrosis · Pyonephrosis · Reflux nephropathy
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Any/all
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Acute tubular necrosis
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Interstitium
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Interstitial nephritis (Pyelonephritis, Danubian endemic familial nephropathy)
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Any/all
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General syndromes
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Renal failure (Acute renal failure, Chronic renal failure) · Uremic pericarditis · Uremia
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Vascular
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Renal artery stenosis · Renal Ischemia · Hypertensive nephropathy · Renovascular hypertension · Renal Cortical Necrosis
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Other
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Analgesic nephropathy · Renal osteodystrophy · Nephroptosis · Abderhalden-Kaufmann-Lignac syndrome
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Ureter
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Ureteritis · Ureterocele · Megaureter
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| Pelvic |
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Bladder
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Cystitis (Interstitial cystitis, Hunner's ulcer, Trigonitis, Hemorrhagic cystitis) · Neurogenic bladder · Bladder sphincter dyssynergia · Vesicointestinal fistula · Vesicoureteral reflux
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Urethra
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Urethritis (Non-gonococcal urethritis) · Urethral syndrome · Urethral stricture/Meatal stenosis · Urethral caruncle
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| Any/all |
Obstructive uropathy · Urinary tract infection · Retroperitoneal fibrosis · Urolithiasis (Bladder stone, Kidney stone, Renal colic) · Malacoplakia · Urinary incontinence (Stress, Urge, Overflow)
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noco/acba/cong/tumr, sysi/epon, urte
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proc/itvp, drug (G4B), blte, urte
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Immune disorders: hypersensitivity and autoimmune diseases (279.5–6)
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Type I/allergy/atopy
(IgE) |
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Foreign
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Atopic dermatitis · Allergic urticaria · Hay fever · Allergic asthma · Anaphylaxis · Food allergy (Milk, Egg, Peanut, Tree nut, Seafood, Soy, Wheat), Penicillin allergy
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Autoimmune
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none
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Type II/ADCC
(IgM, IgG) |
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Foreign
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Pernicious anemia · Hemolytic disease of the newborn
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Autoimmune
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Cytotoxic
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Autoimmune hemolytic anemia · Idiopathic thrombocytopenic purpura · Bullous pemphigoid · Pemphigus vulgaris · Rheumatic fever · Goodpasture's syndrome
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"Type 5"/receptor
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Graves' disease · Myasthenia gravis
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Type III
(Immune complex) |
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Foreign
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Henoch–Schönlein purpura · Hypersensitivity vasculitis · Reactive arthritis · Farmer's lung · Post-streptococcal glomerulonephritis · Serum sickness · Arthus reaction
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Autoimmune
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Systemic lupus erythematosus · Subacute bacterial endocarditis · Rheumatoid arthritis
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Type IV/cell-mediated
(T-cells) |
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Foreign
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Allergic contact dermatitis · Mantoux test
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Autoimmune
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Diabetes mellitus type 1 · Hashimoto's thyroiditis · Guillain–Barré syndrome · Multiple sclerosis · Coeliac disease · Giant-cell arteritis
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GVHD
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Transfusion-associated graft versus host disease
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Unknown/
multiple |
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Foreign
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Hypersensitivity pneumonitis (Allergic bronchopulmonary aspergillosis) · Transplant rejection · Latex allergy (I+IV)
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Autoimmune
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Sjögren's syndrome · Autoimmune hepatitis · Autoimmune polyendocrine syndrome (APS1, APS2) · Autoimmune adrenalitis · Systemic autoimmune disease
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cell/phys/auag/auab/comp, igrc
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