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PATHOGENESIS OF PSGN

PATHOGENESIS OF PSGN. the person gets throat or skin infection antibodies to streptoccocus (ASO )are formed in his circulation complements levels are low compatible with involvement of the complement system as the mediator of the immune reaction

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PATHOGENESIS OF PSGN

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  1. PATHOGENESIS OF PSGN

  2. the person gets throat or skin infection • antibodies to streptoccocus (ASO )are formed in his circulation • complements levels are low compatible with involvement of the complement system as the mediator of the immune reaction • immune complexes now pass through the glomerulus • immune complexes get deposited in the mesangium and along basement membrane • cytoplasmic antigen - endostreptosin and several streptoccocal antigen found in the glomeruli

  3. “THE RED SEA” • History: • 18 yo female • Pedal edema • Severe cough and sore throat (2 wks PTA) • Amoxicillin 500mg 3/day for 4 days • Cola colored urine (4 days PTA) • Bipedal edema (2 days PTA)

  4. “THE RED SEA” • Physical examination: • VS: • BP 150/100 • CR 80/min reg • RR 20/min • T 37C • (+) costovertebral angle tenderness • (+) pedal edema

  5. “THE RED SEA” • Lab Exams:

  6. “THE RED SEA” • Lab Exams: • Hb: 13 g/L • Hct: 0.39 • Creatinine: 1.8 mg/dL • Serum K: 5.2 mEq/L • Serum Na: 129

  7. What is the nephrologic syndrome present in this case?

  8. Hematuria • BP 150/100 • Urinalysis • RBC 50-60/ hpf • Albumin ++ Nephritic Syndrome

  9. What is the most likely cause of this syndrome

  10. Severe cough and sore throat • Post streptococcal Glomerulonephritis - Skin and sore throat infections -M types 1,2,3,4,25,49,12 - develops 1-3 weeks after streptococcal pharyngitis

  11. What lab tests would you request to confirm your diagnosis?

  12. Renal biopsy - hypercellularity of mesangial and endothelial cells - infiltrates of PMN - granular and subendothlial deposits Diagnostic

  13. PATHOPHYSIOLOGY • circulating antigen-antibody complexes are deposited in the glomeruli or free antigen is bound to antibodies trapped in the capillary network • insoluble Ag-Ab complex precipitates in the basement membrane of the glomerular capillaries • cells of the glomeruli proliferate --> reduced GFR

  14. DIAGNOSTIC APPROACH TO HEMATURIA

  15. DIAGNOSIS • begins with the history and physical exam • a history of recent sore throat or skin infection and kidney problem

  16. HEMATURIA • Urinalysis and sediment examination • Look for protein, blood, RBCs and WBCs, dysmorphic red cells, acanthocytes, cellular (RBC, WBC) casts, granular casts, and oval fat bodies • Finding RBC casts is an almost pathognomonic sign of GN. • Urine electrolytes, urine sodium, and fractional excretion of sodium (FENa) assays are needed to assess salt avidity.

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