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About
- Causes โ ๏ธ: Haematuria ๐ฉธ and oliguria ๐ฑ with low BP โฌ๏ธ caused by an immune-mediated response in the kidneys.
- Presentation ๐ฉบ: Commonly presents with kidney inflammation.
- Peak Age ๐ถ: Around 7 years old.
Uncomplicated Presentation
- Haematuria ๐ฉธ, Oliguria ๐ฑ, Low blood pressure (50% of cases) โฌ๏ธ
- Periorbital oedema ๐๏ธ, Fever ๐ก๏ธ
- Gastrointestinal disturbances ๐คข, Loin pain โก
- Hypertensive Encephalopathy ๐ง : Restlessness ๐, Drowsiness ๐ด, Severe headache ๐คฏ, Seizures โก, Vision loss ๐โ, Vomiting ๐คฎ, Coma ๐
- Uraemia ๐งช: Acidosis, Muscle twitching ๐ข, Stupor, Coma
- Cardiac failure โค๏ธโ with fluid overload ๐ง
Causes of Nephritis
- Group A ฮฒ-hemolytic streptococcus ๐ฆ , often following a sore throat ๐ท
- HenochโSchรถnlein purpura (HSP) โจ
- Toxins or heavy metals โ ๏ธ
- Berger's disease (IgA nephropathy) ๐งฌ
- Malignancies ๐๏ธ
- Viruses ๐ฆ
- Bacteria ๐งซ (e.g., infective endocarditis, syphilis)
- Renal vein thrombosis ๐ฉธ
Blood Tests ๐งช
- Full blood count (FBC) ๐งพ
- Urea and electrolytes (U&E) ๐ง, including creatinine, potassium, bicarbonate, calcium, phosphate, and albumin
- Complement levels ๐งฌ (low C3, normal C4)
- ASOT/anti-DNase B ๐ฆ (post-streptococcal infection)
- Antinuclear factor (ANA) ๐งช, anti-DNA antibodies (if lupus suspected)
- ANCA ๐ฌ (if vasculitis suspected)
- Syphilis serology ๐งซ
- Blood cultures ๐
- Virology testing ๐งพ
Urine Tests ๐ง
- Microscopic urinalysis ๐ฌ: RBCs, WBCs, hyaline/granular casts; red cell casts ๐ glomerular bleeding
- Urine culture and specific gravity โ๏ธ (infants ~1.002โ1.006; child/adult ~1.001โ1.035)
Other Tests ๐ฉป
- Throat swabs ๐งซ
- Urgent renal ultrasound (US) ๐ผ๏ธ
- Chest X-ray (CXR) ๐ธ if fluid overload suspected
Treatment ๐
Supportive treatment is essential ๐ฅ
- Fluid balance ๐ง
- Treat hypertension ๐
- Manage infections ๐ฆ
- Restrict dietary sodium ๐ง and fluids ๐ง to prevent overload
- Diuretics ๐ for oedema
- Antihypertensives ๐ (e.g., ACE inhibitors, ARBs)
- Monitor renal function ๐ regularly
- Renal replacement therapy ๐ฉธ (dialysis) in severe cases