PIGN

POST INFECTIOUS GLOMERULONEPHRITIS (PIGN)

Dr. Nariman Fahmi Ahmed Azat

Introduction

The main functions of the kidneys are Controlling the balance of fluid and electrolytes Controlling acid base balance passing the waste products to bladder as urine controlling blood pressure

your kidneys.

Introduction


Any disease of the kidney filters considered serious because it interferes with the basic functions of the kidneys.

PIGN

*One of the oldest recognized renal diseases. Before named as :Acute poststreptococcal glomerulonephritis (APSGN) Currently :Post Infectious glomerulonephritis (PIGN)


Pathogeneic agents mainly group A streptococcus (Nephritogenic strains M types 1,2, 4,12, 18, 25, 49, 55, 57, 60 )
Pathogeneic agent could also includes staph ,gram negative bacteria ,others

Pathogenesis

glomerular-immune complex formation

Post-Infectious GN

Clinical presentation: 3 phase sequence: infection - interval - nephritic syndrome The severity of renal involvement varies from asymptomatic microscopic hematuria with normal renal function to acute renal failure.

Richard Bright 1927 Acute Glomerulonephritis

Abrupt onset Hematuria(coca couloured) Oliguria( Reduced GFR) Oedema (Salt and water retension) Hypertension

Periorbital swelling

DIAGNOSIS
Urinalysis demonstrates red blood cells (RBC) frequently in association with RBC casts mild proteinuria, polymorphonuclear leukocytes (Granular cast).

DIAGNOSIS

A mild normochromic anemia. The serum C3 level is usually reduced in the acute phase and returns to normal 6–8 wk after onset positive throat culture report may support the diagnosis The antistreptolysin O titer is commonly elevated after a pharyngeal infectionanti-deoxyribonuclease (DNase) B level after cutaneous infection.

Treatment

Conservative management BP control (hypertension) Diuresis (oliguria,Oedema) Treatment of infection (throat or Skin)



Treatment


Treatment is focused on relieving symptoms Restriction of salt and fluid Antibiotics (ex. Penicillin), for streptococcal bacteria. Blood pressure medications diuretic medications may be needed to control swelling and high blood pressure.

Dialysis ??

prognosis

Usually mild disease recovery typically within weeks ( 95% )

Possible Complications

Congestive heart failure pulmonary edema Hyperkalemia High blood pressure (hypertension) Acute renal failure Chronic glomerulonephritis

Acute Glomerulo Nephritis Case Scenarios

5 yr Girl Sudden onset Facial puffiness Oliguria & Cola colored urine Generalized oedema Headache Preceding infected skin lesion following trauma No other specific features Physical Examination – Generalized Oedema, Hypertension

On Evaluation :

Urine coke colored 1-2 + proteinuria Red blood cells, red cell and granular casts normal B. Urea 68-102-145mgm/dl S. Creatinine 0.8—1.6—3-4 mgm/dl S.Sodium / Potassium 128/5.8—132/6.4meq/L ASO Positive Serum Complement C3 – 0.3 mgm/dl (0.9- 1.2 mgm/dl)

How do you manage this patient?? What is the possible complications in this case??

Thank you

References