Goroll Primary Care Medicine Pdf File

• Goroll Primary Care Medicine Pdf Files

Acute proliferative glomerulonephritis is a disorder of the glomeruli (glomerulonephritis), or small blood vessels in the kidneys. It is a common complication of bacterial infections, typically skin infection by Streptococcus bacteria types 12, 4 and 1 (impetigo) but also after streptococcal pharyngitis, for which it is also known as postinfectious or poststreptococcal glomerulonephritis.^[3] It can be a risk factor for future albuminuria.^[4] In adults, the signs and symptoms of infection may still be present at the time when the kidney problems develop, and the terms infection-related glomerulonephritis or bacterial infection-related glomerulonephritis are also used.^[5] Acute glomerulonephritis resulted in 19,000 deaths in 2013, down from 24,000 deaths in 1990 worldwide.^[6]

• 4Diagnosis
• 6Treatment

1. Jun 14, 2014. Special consideration is given to team-based approaches of primary care delivery, recognizing its increasing importance to achieving high levels of practice performance. Primary Care Medicine's digital format and quarterly updates ensure current, point-of-care decision support. New, online resources.
2. Department of Community Services Section of Behavioral heath. Retrieved December 10, 2011 from /CBhSDM04rev.pdf Burroughs, V.J., et al. Racial and ethnic differences in response to medicines: towards individualized pharmaceutical treatment. Journal of the National Medical.

Signs and symptoms[edit]

Feder, IL (2011), A health plan spurs transformation of primary care practices into better-paid medical homes, Health Affairs 30, 397-399. Ginsburg, PB. (2011), Spending to save — ACOs and the medicare shared savings program, New England Journal of Medicine 364, 2085-2086. (2011), Payment reform to.

Among the signs and symptoms of acute proliferative glomerulonephritis are the following:

• Hematuria^[7]
• Oliguria^[8]
• Edema^[9]
• Hypertension^[9]
• Fever (headache, malaise, anorexia, nausea.)^[10]

Causes[edit]

Acute proliferative glomerulonephritis (post-streptococcal glomerulonephritisis) is caused by an infection with streptococcus bacteria, usually three weeks after infection, usually of the pharynx or the skin, given the time required to raise antibodies and complement proteins.^[11][12] The infection causes blood vessels in the kidneys to develop inflammation, this hampers the renal organs ability to filter urine.^{[citation needed]} Acute proliferative glomerulonephritis most commonly occurs in children.^[12]

Pathophysiology[edit]

Goroll Primary Care Medicine Pdf Files

The pathophysiology of this disorder is consistent with an immune-complex-mediated mechanism, a type III hypersensitivity reaction. This disorder produces proteins that have different antigenic determinants, which in turn have an affinity for sites in the glomerulus. As soon as binding occurs to the glomerulus, via interaction with properdin, the complement is activated. Complement fixation causes the generation of additional inflammatory mediators.^[1]

Complement activation is very important in acute proliferative glomerulonephritis. Apparently immunoglobulin (Ig)-binding proteins bind C4BP. Complement regulatory proteins (FH and FHL-1), may be removed by SpeB, and therefore restrain FH and FHL-1 recruitment in the process of infection.^[13]

Diagnosis[edit]

The following diagnostic methods can be used for acute proliferative glomerulonephritis:^[1]

• Complement profile
• Imaging studies
• Blood chemistry studies

Clinically, acute proliferative glomerulonephritis is diagnosed following a differential diagnosis between (and, ultimately, diagnosis of) staphylococcal and streptococcal impetigo. Serologically, diagnostic markers can be tested; specifically, the streptozyme test is used and measures multiple streptococcal antibodies: antistreptolysin, antihyaluronidase, antistreptokinase, antinicotinamide-adenine dinucleotidase, and anti-DNAse B antibodies.^[1]

Differential diagnosis[edit]

The differential diagnosis of acute proliferative glomerulonephritisis is based on the following:^{[citation needed]}

1. Causes of acute glomerulonephritis:
   • IgA Nephropathy
   • Type 1 membranoproliferative glomerulonephritis
   • Bacterial endocarditis
2. Causes of generalized edema:
   • Renal affection
   • Liver cell failure
   • Right side heart failure

Prevention[edit]

It is unclear whether or not acute proliferative glomerulonephritis (i.e., poststreptococcal glomerulonephritis) can be prevented with early prophylacticantibiotic therapy, with some authorities arguing that antibiotics can prevent development of acute proliferative glomerulonephritis^[14]

Treatment[edit]

Acute management of acute proliferative glomerulonephritis mainly consists of blood pressure (BP) control. A low-sodium diet may be instituted when hypertension is present. In individuals with oliguric acute kidney injury, the potassium level should be controlled.^[1] Thiazide or loop diuretics can be used to simultaneously reduce edema and control hypertension; however electrolytes such as potassium must be monitored. Beta-blockers, Calcium channel blockers, and/or ACE inhibitors may be added if blood pressure is not effectively controlled through diureses alone.^[1]

Epidemiology[edit]

Acute glomerulonephritis resulted in 19,000 deaths in 2013 down from 24,000 deaths in 1990.^[6]

References[edit]

1. ^ ^abcdefghAcute Poststreptococcal Glomerulonephritis Workup at eMedicine
2. ^GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). 'Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015'. Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC5055577. PMID27733282.
3. ^Baltimore RS (February 2010). 'Re-evaluation of antibiotic treatment of streptococcal pharyngitis'. Curr. Opin. Pediatr. 22 (1): 77–82. doi:10.1097/MOP.0b013e32833502e7. PMID19996970.
4. ^White AV, Hoy WE, McCredie DA (May 2001). 'Childhood post-streptococcal glomerulonephritis as a risk factor for chronic renal disease in later life'. Med. J. Aust. 174 (10): 492–6. PMID11419767.
5. ^Nasr SH; Radhakrishnan J; D'Agati VD (May 2013). 'Bacterial infection-related glomerulonephritis in adults'. Kidney Int. 83 (5): 792–803. doi:10.1038/ki.2012.407. PMID23302723.
6. ^ ^abGBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). 'Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013'. Lancet. 385 (9963): 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC4340604. PMID25530442.
7. ^Tasic, Velibor (2008). 'Postinfectious Glomerulonephritis'. Comprehensive Pediatric Nephrology. pp. 309–317. doi:10.1016/B978-0-323-04883-5.50026-X. ISBN978-0-323-04883-5.
8. ^Wilkiins, Lippincott Williams & (2015-01-16). Handbook of Signs & Symptoms. Lippincott Williams & Wilkins. ISBN9781496310545.
9. ^ ^abSurgeons, American Academy of Orthopaedic; Physicians, American College of Emergency (2009-11-13). Critical Care Transport. Jones & Bartlett Learning. p. 959. ISBN9780763712235.
10. ^Garfunkel, Lynn C.; Kaczorowski, Jeffrey; Christy, Cynthia (2007-07-05). Pediatric Clinical Advisor: Instant Diagnosis and Treatment. Elsevier Health Sciences. p. 223. ISBN9780323070584.
11. ^Marianne Gausche-Hill, Susan Fuchs, Loren Yamamoto, American Academy of Pediatrics, American College of Emergency Physicians. 'APLS: The Pediatric Emergency Medicine Resource'. Jones & Bartlett Learning; 2004.
12. ^ ^ab'Post-streptococcal glomerulonephritis (GN): MedlinePlus Medical Encyclopedia'. www.nlm.nih.gov. Retrieved 2015-10-31.
13. ^Rodríguez-Iturbe, B.; Batsford, S. (June 2007). 'Pathogenesis of poststreptococcal glomerulonephritis a century after Clemens von Pirquet'. Kidney International. 71 (11): 1094–1104. doi:10.1038/sj.ki.5002169. PMID17342179.
14. ^Rodriguez-Iturbe, Bernardo; Musser, James M. (October 2008). 'The Current State of Poststreptococcal Glomerulonephritis'. Journal of the American Society of Nephrology. 19 (10): 1855–1864. doi:10.1681/ASN.2008010092. PMID18667731.

Further reading[edit]

• Group A Streptococcal Infections - National Institute of Allergy and Infectious Diseases
• Wilkins, Lippincott Williams & (2004-01-01). Rapid Assessment: A Flowchart Guide to Evaluating Signs and Symptoms. Lippincott Williams & Wilkins. ISBN9781582552729.

External links[edit]