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streptococcal GN
APSGN
Pathogenesis :
-
Pathology :
-
diffuse proliferative GN
LM : proliferation of endoth , epith , mesangial cells
capillaries .
Immunofluorescent : granular deposit of IgG , C3 .
EM : subepithelial deposits humps .
--------> occlusion of
Clinical picture
Complication
Hypertensive Heart failure
:
tachycardia - tachypnea - enlarged tender
liver .
Hypertensive encephalopathy :
Headache - vomiting - convulsion .
Renal impairement
:
( transient ) , but may progress to RPGN ------->
acidosis .
Investigation
Urine analysis
- Volume : oliguria
( < 400 ml / m / day ) .
- Aspect : smoky urine ( cola coloured urine ) .
- Proteins : proteinuria ( mild ) .
- Sp . gravity :
D .D :
-
Treatment
Prevention : early ttt of strept . infection not risk of APSGN .
TTT
Monitoring : dailt wt . - urine output / 24 h - Bl . pressure - Odema .
Diet
- Salt restriction .
- Fluid restriction .
[ fluid intake = urine ouput + insensible water
loss 400 ml / m / d
- CHO , proteins , fats .
TTT of odema
- Thiazide
( chlorothiazide ) 1 2 mg/kg/day .
- Loop diuretic
(
frusemide
) 1 2 mg/kg/day .