Disease |
NEPHRITIS |
|
|
Definition |
An immunologically mediated response, (mostly to infection in the tropics, usually post streptococcal and manifesting 1-3 weeks after the infection), and leading to damage to glomeruli that can result in damage to the basement membrane and capillary endothelim. |
|
|
Prognosis |
Depends on histology and best in those with minimal change GN and focal segmental proliferative GN. Immediate mortality >5%. Long-term prognosis excellent in children with 95% recovering completely and recover of renal function within 8-12 weeks in 955 of patients with post-streptococcal nephritis. Proteinuria might persist for 3 months, and microscopic heamaturia for up to 24 months. More morbidity in adults and those with pre-existing renal disease. Poorer prognosis in those with heavy proteinuria, severe hypertension and significant elevations of creatinine. Proteinuria might persist for 3 months and microscopic heamaturia for up to 24 months.
|
|
|
General Measures |
As detailed under In-patient care.
|
|
|
Advice to Patient |
Strict monitoring after discharge. Restriction of salt, protein, and avoidance of potassium rich foods until oedema, and hypertension clear. Heamaturia possible after vigorous exercise for 1-2 years. Abnormal urinalysis may persist for many years.
|
|
|
Follow Up |
Urinalysis and monitoring serum creatinine after ½ 1,2,4,6, and 12 months. Monitor BP at each visit. There is no need for long-term anti-streptococcal prophylaxis. Stop follow up when urinalysis is normal.
|
|
|
Inadequate Response |
In cases of development of rapidly progressive Glomerulonephritis, Nephrotic syndrome or end stage renal failure, and calls for nephrologists care.
|
|
|
Prevention |
Aggressive treatment of streptococcal infections with penicillin or erythromycin.
|
|
|
Reference From |
www.emedicine.com /emerg/topic219.html |