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Clinical & laboratory indications of secondary causes of GN. Known extra renal diseases that causes GN. Infections Post-streptococcal glomerulonephritis. Bacterial endocarditis Viral infections Immune diseases Systemic Lupus erythematosus Goodpasture's syndrome. IgA nephropathy.
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Known extra renal diseases that causes GN • Infections • Post-streptococcal glomerulonephritis. • Bacterial endocarditis • Viral infections • Immune diseases • Systemic Lupus erythematosus • Goodpasture's syndrome. • IgA nephropathy. • Vasculitis • Polyarteritis • Wegener's granulomatosis
Post-streptococcal glomerulonephritis • Definition: The patient suffers a strep infection 1-3 weeks before onset of GN • organism: Group A beta-hemolytic Streptococcus • More common in children
Late complications • Rheumatic fever, post-streptococcal glomerulonephritis
Viral Infections • HIV • Seroconversion/primary illness: 6-8wks after inf. Lasts 3 weeks, full recovery • Symp: fever, arthralgia, myalgia, lethargy, lymphadenopathy, sore throat, mucosal ulcers, & faint pink maculopapular rash • Neuro: headache, photophobia, myelopathy, neuropathy, rarer: encephalopathy • Lymphopenia w atypical reactive lymphocytes
Hep B/ C • Investigations: LFT, Bloods LFT • Prodromal stage: Bilirubin is normal • Bilirubinuria • ↑ Urinary urobilinogen • ↑ ↑ AST/ ALT • Icteric stage: Bilirubin reflects the level of jaundice • AST reaches a maximum >500 IU/L • ALP <300 IU/L
Haematological test • Leucopenia • Lymphocytosis • Rare: Coombs’ – positive haemolytic anaemia w. ass. Aplastic anaemia • Severe: PT time prolonged • ↑ESR