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 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

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)

THE RED SEA

Physical examination:
VS:
BP 150/100 CR 80/min reg RR 20/min T 37C

(+) costovertebral angle tenderness (+) pedal edema

THE RED SEA

Lab Exams:
Urinalysis Color Turbidity Specific gravity pH Albumin Glucose Dark Turbid 1.023 6 ++ -

RBC
WBC Casts

50-60/hpf
7.5 x 109 /L RBC cast (2-3/hpf) Granular cast (1-2/hpf)

THE RED SEA

Lab Exams:
Hb: Hct: Creatinine: Serum K: Serum Na: 13 g/L 0.39 1.8 mg/dL 5.2 mEq/L 129

What is the nephrologic syndrome present in this case?

 Hematuria BP 150/100

Urinalysis
RBC 50-60/ hpf Albumin ++

Nephritic Syndrome

What is the most likely cause of this syndrome

 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

What lab tests would you request to confirm your diagnosis?

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

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

DIAGNOSTIC APPROACH TO HEMATURIA

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

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.