Glomerulonephritis akut Glomerulonephritis akut post streptococcuspost streptococcus

Glomerular disease :Glomerular disease :Most often in children ( 3 and 7 ages )Most often in children ( 3 and 7 ages )Usually appear 1 – 2 weeks post infection Usually appear 1 – 2 weeks post infection ( follows streptococcal skin infection than ( follows streptococcal skin infection than streptococcal pharyngitis )streptococcal pharyngitis )

Elevated Antistreptolysin O ( ASO ) during the Elevated Antistreptolysin O ( ASO ) during the nephritic stage ( specific nephritogenic strain nephritic stage ( specific nephritogenic strain of group A streptocuccus )of group A streptocuccus )

Bacteri do not enter the blood, urine and Bacteri do not enter the blood, urine and kidney kidney

but streptococcal circulated and elicits the but streptococcal circulated and elicits the formation of anti body formation of anti body

-> immune complex -> deposit in the -> immune complex -> deposit in the glomeruli and active glomeruli and active

complement complement

-> damage glomerular basement -> damage glomerular basement membrane membrane

-> obstruction of the glomerular -> obstruction of the glomerular capillaries capillaries

by endothelial proliferation and by endothelial proliferation and swelling.swelling.

Tubular function is less severely impaired Tubular function is less severely impaired than glomerular function.than glomerular function.

The disease heal spontan or conservative The disease heal spontan or conservative therapy ( 95% children )therapy ( 95% children )

The rapidly progressive form of GNA and The rapidly progressive form of GNA and another small slow progression to GNC another small slow progression to GNC with CRF ( a small minority paediatric with CRF ( a small minority paediatric patien )patien )

Laboratory findingsLaboratory findingsCultur throad of streptococcal infectionCultur throad of streptococcal infection

Increased : ASO Increased : ASO

1 - 3 weeks post infection peaks 3-5 1 - 3 weeks post infection peaks 3-5 weeksweeks

50 % show no rise in ASO titer, 50 % show no rise in ASO titer,

thus height of the titer dost not reflect thus height of the titer dost not reflect severity of the renal diseaseseverity of the renal disease

Urine : Urine :

hematuria macro and microscopic 1-2 hematuria macro and microscopic 1-2 weeks weeks and last 2 – 12 monthsand last 2 – 12 months

Lekocytoria Lekocytoria

Sediment : RBC, WBC, granular, hyalin, Sediment : RBC, WBC, granular, hyalin, fattyfatty

Proteinuria ( < 3 gr / day ) diappears Proteinuria ( < 3 gr / day ) diappears before before hematuria dan oligurihematuria dan oliguri

Blood : Blood :

increased BUN and Creatinineincreased BUN and Creatinine

decreased creatinine clearencedecreased creatinine clearence

increased sediment rate ( ESR )increased sediment rate ( ESR )

leukocytosis neutrophyl dominantleukocytosis neutrophyl dominant

normocytic anemia due to hemodilution, normocytic anemia due to hemodilution,

BloodBlood

marrow depression or increasemarrow depression or increase

RBC depressionRBC depression

Decrease serum complement Decrease serum complement

occurs 24 hours before the onset occurs 24 hours before the onset hematuria hematuria

Decreased albuminDecreased albumin

increase alfa 2 globulin increase alfa 2 globulin

the former reflect urinaria lossthe former reflect urinaria loss

-> indicate acute inflamation-> indicate acute inflamation

Nephrotic sindromeNephrotic sindromeCharacterized : Characterized :

by marked proteinuria, by marked proteinuria, decrease plasma protein, decrease plasma protein, generalized edema, rise in serum lipidsgeneralized edema, rise in serum lipids

Renal and systemic disease might be Renal and systemic disease might be associated with the nephrotic syndromeassociated with the nephrotic syndrome

Glomerulonephritis, Glomerulonephritis,

circulatory disturbances ( renal vein circulatory disturbances ( renal vein thrombosis ), toxin,thrombosis ), toxin,

Systemic disease , infection, Systemic disease , infection, malignancymalignancy

Primary renal disease causing nephrotic Primary renal disease causing nephrotic syndrome is membranous nephritissyndrome is membranous nephritis

Proteinuria : Proteinuria : Glomerular protein leaked -> Glomerular protein leaked -> failure of tubular protein reabsorption -> failure of tubular protein reabsorption -> protein loss in the urine consist albumin protein loss in the urine consist albumin ( 1/3 Ig G ) -> hipoalbunemia( 1/3 Ig G ) -> hipoalbunemia

Edema : Edema : Hipoproteinemia -> Hipoproteinemia -> the loss of colloid oncotic pressure-> the loss of colloid oncotic pressure-> fluids to leak from blood vessels into the fluids to leak from blood vessels into the intertitial space -> intertitial space -> reduce plasma volume and cardiact out reduce plasma volume and cardiact out put -> releasing renin -> put -> releasing renin -> stimulates aldosterone -> stimulates aldosterone -> retention of sodium and water -> retention of sodium and water -> water leak into the intertitial space ->water leak into the intertitial space ->edemaedema

Hyperlipidemia and lipiduriaHyperlipidemia and lipiduria

Increase plasma lipid -> due to increased Increase plasma lipid -> due to increased lipid synthesis and decreased lipid -> lipid synthesis and decreased lipid ->

result from increased glomerular result from increased glomerular permeablitypermeablity

Laboratorium findingsLaboratorium findings

Increased urine protein ( albumin ) Increased urine protein ( albumin ) ( > 3,5 gr / 24 hr -- > 20 gr / hr )( > 3,5 gr / 24 hr -- > 20 gr / hr )Decrease albumin ( usually < 2,5 gr/dl ), Decrease albumin ( usually < 2,5 gr/dl ), Increased : cholesterol ( 350mg/dl ) if to be Increased : cholesterol ( 350mg/dl ) if to be come decreased or normal, occurs -> come decreased or normal, occurs ->

with poor nutrition and or poor prognosis , with poor nutrition and or poor prognosis , increased triglycerides, lipoproteinincreased triglycerides, lipoproteinIncreased alfa and beta globulins Increased alfa and beta globulins Decreased gama globulin ( IgG )Decreased gama globulin ( IgG )

Urine ; Urine ;

Oval fat bodies ( are lipid containing renal Oval fat bodies ( are lipid containing renal tubular epithelial cell )tubular epithelial cell )

Increased sedimentation rate due to Increased sedimentation rate due to increased fibrinogenincreased fibrinogen

Decreased serum calcium reflect fall in Decreased serum calcium reflect fall in serum albumin, ( Ca ion normal )serum albumin, ( Ca ion normal )