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Acute Glomerulonephritis

Post-infectious acute glomerulonephritis is the most common acute glomerulonephritis and nephritis. A typical case would be of an eight-year-old boy who is brought to the pediatrician because of swelling of the eyes and legs, tiredness and headaches for two days after completing a 10-day course of penicillin for a strep throat infection. The urine is noticed to be Coca-Cola colored and the mother, for instance, can be the one saying these words. On physical exam the blood pressure will be 150/85, high, edema of the lower extremities, lungs are clear to auscultation however on an x-ray there is increased vascular markings and an enlarged heart. The urinalysis reveals 3+ proteinuria and too numerous to count red blood cells, and RBC casts.

In the blood, other than the features of renal failure, including an increase in BUN, hyponatremia from the overload, and hyperkalemia from renal failure, thereís these very important things to remember. A very depressed C-3 early on in the disease and if itís relevant, anti-DNAís titers are elevated, the strep antibodies. Cultures can be positive or negative.

Treatment with antibiotics doesnít prevent the acute glomerulonephritis but it does, or may, attenuate the severity. So it should be treated but itís not prevention of the actual glomerulonephritis. You treat the acute renal failure, including all the features that you know can happen in acute renal failure, like hypertension, hyperkalemia, etc. Some people even culture family members.

The natural course of acute glomerulonephritis is that of almost 100% itís a self-limiting disease, doesnít go on to chronic renal failure, kids get better, the complement gets back to normal in 6-8 weeks, and they can still have hematuria for about 6-12 months, especially when they have some upper respiratory infection or other infection, it can return.

Membranoproliferative glomerulonephritis. Weíve already mentioned it. MPGN. The case that will represent it is that of a 10-year-old girl who wakes up in the morning with swollen eyes and who is pale. Examined by the pediatrician, was found to have a blood pressure thatís elevated, pretibial pitting, edema, bilateral decreased breath sounds - that we already know is pleural effusions - urinalysis with 4+ proteinuria and large blood, 50-100 RBCís and blood tests with a creatinine that is already elevated for age and size, chronic renal failure, albumin is low, there is a nephrotic syndrome and the C-3 is very very depressed complement, and anemia. So this person could also have acute glomerulonephritis. Everything fits, however there will be the low