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Clinical & laboratory indications of secondary causes of GN. Known extra renal diseases that causes GN. Infections Post-streptococcal glomerulonephritis. Bacterial endocarditis Viral infections Immune diseases Systemic Lupus erythematosus Goodpasture's syndrome. IgA nephropathy. - PowerPoint PPT Presentation
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Clinical & laboratory indications of secondary causes of GN
Known extra renal diseases that causes GN
• Infections– Post-streptococcal
glomerulonephritis.– Bacterial endocarditis– Viral infections
• Immune diseases– Systemic Lupus
erythematosus– Goodpasture's syndrome.– IgA nephropathy.
• Vasculitis– Polyarteritis– Wegener's granulomatosis
Post-streptococcal glomerulonephritis
• Definition: The patient suffers a strep infection 1-3 weeks before onset of GN
• organism: Group A beta-hemolytic Streptococcus
• More common in children
Group A streps
Conditions Ex findings Investigations
Septicaemia Fever, GI symp, Abdo pain, SOB, Tachy
FBE, U&E, LP, swab, sputum sample
Wound/ skin infections
blisters Swab
Tonsillitis red swollen tonsils, purulent exudate
FBESwab
Scarlet fever rash on chest, neck, skin folds & inner thigh
Throat culture, Rapid antigen test, Rapid DNA test
Necrotising fasciitis Fever, severe pain, swelling, heat, redness
?
Late complications
• Rheumatic fever, post-streptococcal glomerulonephritis
Condition Ex findings Investigations
Endocarditis abnormal heart rhythm, murmur (may indicate inflammation)
ECGECHO
UTI dysuria, urgency, frequency (↓vol), suprapubic pain
+/- haematuria, loin pain, vomiting
FBEU&EMSU
Toxic shock fever, dizziness, confusion -no specific test-FBEU&EMSUSwabs – throat, vagina
Viral Infections
• HIV– Seroconversion/primary illness: 6-8wks after inf.
Lasts 3 weeks, full recovery
– Symp: fever, arthralgia, myalgia, lethargy, lymphadenopathy, sore throat, mucosal ulcers, & faint pink maculopapular rash
– Neuro: headache, photophobia, myelopathy, neuropathy, rarer: encephalopathy
– Lymphopenia w atypical reactive lymphocytes
• Hep B/ C– Investigations: LFT, Bloods
LFT• Prodromal stage: Bilirubin is normal
– Bilirubinuria
– ↑ Urinary urobilinogen
– ↑ ↑ AST/ ALT
• Icteric stage: Bilirubin reflects the level of jaundice– AST reaches a maximum >500 IU/L– ALP <300 IU/L
• Haematological test– Leucopenia– Lymphocytosis– Rare: Coombs’ – positive haemolytic anaemia w.
ass. Aplastic anaemia– Severe: PT time prolonged– ↑ESR
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