Acute Glomerular Nephritis Research Articles

Clinical Spectrum of Acute Post-streptococcal Glomerulonephritis in Children: A Kashmir Experience.

Background In the pediatric population, acute post-streptococcal glomerulonephritis (PSGN) is a common glomerular etiology of hematuria and acute hypertension leading to hospitalization. We conducted this study to know the clinical profile and occurrence of acute PSGN in patients presenting with features of acute nephritic syndrome. Methods This prospective observational study was conducted on children aged between two and 18 years, presenting with clinical features of acute glomerular nephritis (AGN). After due ethical considerations, all eligible patients were enrolled and underwent detailed clinical assessment, laboratory, and imaging evaluation, followed by protocolized treatment. Relevant data were collected and analyzed to reach valid results. Results Out of 60 patients with AGN, PSGN was found in 83.3% of the patients (50/60). The age group under five years wasthe most commonly involved, with a male/female ratio of 1.6:1. Around half of the studied patients were from the lower middle class, and 40 (80%) were from rural backgrounds. Facial puffiness was the most common clinical presentation, seen in 45 (90%) patients. Hypocomplementemia and proteinuria were seen in all PSGN patients. Pyoderma was the most common preceding infection, seen in 38 (76%) patients, followed by pharyngitis. Acute kidney injury (AKI) was the most common complication, seen in 12 (24%) patients. Complete resolution of the signs and symptoms was seen in 37 (74%) patients at the time of discharge, which increased to 47 (94%) patients at six months post discharge. Conclusion PSGN stands to be the most common cause of pediatric AGN. The population under five years of age, with a past history of pyoderma, is more predisposed to PSGN. The potential for the occurrence of AKI and other life-threatening complications is high, for which early diagnosis and institution of proper treatment would be very beneficial.

Pattern of Childhood Renal Diseases in Aba, South East Nigeria

<i>Background</i>: Renal diseases are currently posing a great health concern worldwide. Proper documentation, knowledge of renal disease burdens, and established renal registries will provide data to guide stake-holders in future planning and resource allocation. This study aims at documenting the pattern and outcome of childhood renal diseases admitted at our centre. <i>Methods</i>: This was a prospective study of all childhood renal diseases admitted into the pediatrics wards of the Abia State University Teaching Hospital, Aba, from October 2013 to October 2018. The demographic characteristics of the patients, ingestion of herbal concoctions, clinical presentation, laboratory investigations, diagnosis and management outcomes were documented, and analysed. <i>Result</i>: A total of 6108 children were admitted into the paediatric wards during the study period. One hundred and four (104) of them had renal diseases, accounting for 1.7% of paediatric admissions. There was male preponderance (55.8%) with a Male: Female ratio of 1.3:1. Sex had significant association with renal diseases (p-<i>Value</i>=0.025). The age range was 0.5 – 16 years with a mean age of 7.9±4.5 years. Majority (40.4%) of the patients were aged 5-10 years (p-<i>Value</i> 0.021). Nephrotic Syndrome (47.1%), Acute Kidney Injury (10.6%) and Acute Glomerular Nephritis (10.6%) were the commonest causes of admission. Proteinuria (39.4%), Oedema (39.4%) and Oliguria (26.9%) were the most frequent clinical presentations. Progressive increase in yearly diagnosis of renal diseases was observed. More than 90% of the patients took herbal remedies before presentation (p-<i>Value</i>=0.001). Mortality rate was 4.8%. Causes of death were Chronic Kidney Disease (40%), Acute Kidney Injury (20%), Wilms tumour (20%), and HIVAN (20%). <i>Conclusion</i>: The prevalence of childhood renal diseases in Aba is 1.7%. Nephrotic syndrome is the commonest cause of renal admission in our centre. Ingestion of herbal concoctions by our cohort was high. There was an annual increment in the number of renal disorders in our centre. Preventive nephrology should be adopted to curb the morbidity and mortality from renal diseases worldwide.

P3-24: Secondary hypertension in a tunisian internal medicine department

Secondary hypertension (SH) refers to arterial hypertension due to an identifiable and often curable cause. It affects approximately 5-10% of the general hypertensive population. SH can be caused by conditions that affect kidneys, arteries, heart or endocrine system. Our aim is to describe the different causes of SH noted in our patients. It is a retrospective study of 240 patients followed for a SH at the Internal Medicine Department of the Tunisian Military Hospital from 2000 to 2015. The diagnosis of SH in these patients was suspected in front of clinical and biological arguments and confirmed by the further explorations guiding a suitable therapeutic attitude. Renal causes were the main etiology of SH (233 patients) with acute glomerular nephritis (AGN) in 4 cases, primary chronic glomerular nephropathy (CGN) in 14 cases, including 8 cases of membranous glomerulonephritis, 2 cases of focal segmental glomerulosclerosis and 4 cases of membrano-proliferative glomerulonephritis. Secondary CGN were dominated by diabetic nephropathy in 174 cases, lupus nephropathy in 10 cases and rheumatoid purpura in one case. Congenital kidney diseases were represented by hereditary polycystic kidney disease in 20 patients and Alport syndrome in 2 patients. The renovascular hypertension was noted in 8 cases. The endocrine causes were present in 6 patients (2 cases of Conn syndrome, 2 cases of hyperthyroidism, 1 case of bilateral adrenal hyperplasia and another case of pheochromocytoma). One patient had SH with a cardiac cause that was aortic coarctation. The prevalence of SH exceeds 30% among patients with resistant hypertension. Common causes include chronic kidney diseases, primary aldosteronism, renovascular hypertension and obstructive sleep apnea. In our study, renal parenchymal disease particularly diabetes is the most common cause of SH. Physicians should be judicious about evaluation of a potentially curable cause of hypertension. Careful clinical evaluation and simple algorithms help avoid unnecessary investigations. In patients with SH, early detection and treatment are important to minimize and prevent irreversible changes in the vasculature and target organs.

The pharmacological properties of anisodamine

Anisodamine is a naturally occurring atropine derivative that has been isolated, synthesized and characterized by scientists in the People's Republic of China. Like atropine and scopolamine, anisodamine is a non-specific cholinergic antagonist exhibiting the usual spectrum of pharmacological effects of this drug class. It appears to be less potent and less toxic than atropine and displays less CNS toxicity than scopolamine. Anisodamine has been shown to interact with and disrupt liposome structure which may reflect its effects on cellular membranes. Experimental evidence implicates anisodamine as an anti-oxidant that may protect against free radical-induced cellular damage. Its cardiovascular properties include depression of cardiac conduction and the ability to protect against arrhythmia induced by various agents. Anisodamine is a relatively weak alpha(1) adrenergic antagonist which may explain its vasodilating activity. Its anti-thrombotic activity may be a result of inhibition of thromboxane synthesis. The T(1/2) of anisodamine in humans is about 2-3 h. Numerous therapeutic uses of anisodamine have been proposed including treatment of septic shock, various circulatory disorders, organophosphorus (OP) poisoning, migraine, gastric ulcers, gastrointestinal colic, acute glomerular nephritis, eclampsia, respiratory diseases, rheumatoid arthritis, obstructive jaundice, opiate addiction, snake bite and radiation damage protection. The primary therapeutic use of anisodamine has been for the treatment of septic shock. Several mechanisms have been proposed to explain its beneficial effect though most mechanisms are based upon the assumption that anisodamine ultimately acts by an improvement of blood flow in the microcirculation. Preliminary studies suggest another important therapeutic use of anisodamine is for the treatment of OP poisoning. Additional research is needed to delineate further the clinical usefulness of anisodamine relative to other anti-muscarinic drugs such as atropine and scopolamine.

Murine fetal resorption and acute glomerular nephritis is induced by both excessive Th1 and Th2 activation

Murine fetal resorption and acute glomerular nephritis is induced by both excessive Th1 and Th2 activation

Causes of Admissions of Rural African Patients to Murchison Hospital, Natal, South Africa

An analysis has been made of causes of admission of black patients in 1991 to Murchison Hospital, Port Shepstone, Natal. Of 6675 total admissions, 6329 (95%) were classifiable. Of the latter, 1462 (23%) were aged 12 years and-younger, namely, 763 boys and 699 girls. Their chief causes of admission were pneumonia, gastroenteritis, trauma, acute glomerular nephritis, and malnutritional diseases. Of 4867 adults (73%), 1536 were males and 3331 females. Among men, chief causes were tuberculosis, congestive cardiac failure, hypertension and cerebral vascular accidents. Among women, apart from pregnancy, chief causes of admission were disorders of pregnancy, tuberculosis, congestive cardiac failure, pneumonia, diabetes, and hypertension. Of western diseases, 3.9% of adults were admitted for diabetes, and 2.8% for asthma. The general pattern of admissions is similar to that in other rural hospitals. The causes of admissions are discussed, regarding (1) public health improvements occurring, and (2) means of promoting further improvements by (a) community self-help, and (b) help from State health and other services.

La glomerulonefritis aguda en el niño: Estudio prospectivo de aspectos clinicos, histopatologicos e inmunologicos

Forty live ehildren (23 boys) 22to 15 years old (mean age 7.7 years) with clinical and histological evidence ofacute glomerular nephritis (AGN) were followed by 30 months. A.II patients were studied with percutaneous renalbiopsies in tlic first month after the begining of the disease (mean 20 days) and in 31 patients, a second renal biopsywas done: in 12 at x 194 days (range 171 to" 212 days) and in 19 at x 590 days (range 418 to 999 days). With only 5exceptions (11.1%) all patients recalled clinical evidence of antecedent cutaneous (37.8%), respiratory (51.1%) orcombined cutaneous and respiratory infections (11.1%) but group A bctha hcmolitycus estrep toco ecus (GABHE)was only isolated from six patients, probably because of previous antibiotic treatment. Edema and hypertensiondissapearcd in a mean of 8.8 and 4.3 days respectively. Haematuria was present in only 44%of the patients in thefirst urine examination, protemuria in 51% and eilindruria in 29.9% of the cases, but at last, hematuria wasdemonstrated in 41 /45 patients; proteinuria, that was present in a!3 cases without hematuria, finally ocurred in 95%of all the affected children and eilindruria was detected in 64%of the total series. A good correlation was found inthe histologic study between the magnitude of the lesions at optic and electronic microscopy. In the first biopsy allpatients showed segmental intramembranous, inrnune deposits. In the second series of renal biopsies the intensity ofthe lesions was, clearly, lesser at six months and the microscopical findings were already normal in three cases at 590days.(Key words: Acute glomerular nephritis, symptoms, evolution, renal biopsy, histologic findings, follow up,prognosis).

Acute and Rapidly Progressive Forms of Glomerulonephritis in the Elderly

This article presents a comparison of acute glomerular nephritis (AGN) with rapidly progressive glomerular nephritis (RPGN) in patients aged 60 or older. In 7 elderly patients with AGN, the renal disease was preceded by skin infection (4 cases), sore throat (2 cases), or pneumonia (1 case). The 7 patients with RPGN had no history of prior infection. Both AGN and RPGN were manifested clinically as acute renal failure, but the RPGN patients had significantly higher serum creatinine levels and lower hematocrit readings. Hypocomplementemia was a feature only of AGN. The biopsy specimens from patients with RPGN showed crescents in 50--100 percent of the glomeruli, whereas specimens from patients with AGN showed no significant extracapillary proliferation. Six AGN patients recovered and 1 died. Despite dialysis, 4 RPGN patients died and the remaining 3 require maintenance dialysis. It is concluded that AGN in the elderly is more common than previously believed, frequently follows skin infections, and has a reasonably good prognosis. In contrast, RPGN, also not rare in the elderly, has a much worse prognosis.

Biochemical changes induced by α-naphthylthiourea in albino rats

Administration of α-naphthylthiourea to albino rats caused excessive urinary excretions of albumin, inorganic phosphorus, and urea in 22 hr. Levels of inorganic phosphorus, glucose, and creatinine were elevated in blood and in the pleural effusion. Urea contents in blood and pleural effusion were progressively increased with concomitant rise in arginase activities. Significant increases were observed in phospholipids, triglycerides, and cholesterol concentrations in blood. No changes were noticed in cholesterol and fat contents of the liver. Kidney sections showed lesions in the glomerular region after 8 hr, and in the later stages, the histopathological evidence was suggestive of acute glomerular nephritis of the lipoidal type.

Bacteraemia by &lt;i&gt;P. aeruginosa &lt;/i&gt;Associated with Nephrotic Syndrome After Shunt Operation for Hydrocephalus

One patient of sepsis by P. aeruginosa after the implanting of a ventriculoatrial valve following extirpation of an expansive intracranial process is studied. During the evolution of the septic process there appeared as associated nephrotic syndrome with histologic lesions corresponding to an acute exudative glomerular nephritis. The germ became resistant to the antibiotics used, carbenicillin plus gentamicin, being later sensitive only to fosfomycin with which finally complete cure was achieved.

Beta-Hemolytic Streptococcal Infection

Evidence indicates that the number of beta-hemolytic streptococci found in cultures has great clinical and epidemiologic significance. In those epidemiologic situations where the frequency of streptococcal infections increases so also does the proportion of strongly positive cultures (degree of positivity ratio). This degree of positivity ratio also increases in groups of ill patients in proportion to the importance of streptococci in those illnesses. In the individual patient, significant clinical disease due to the streptococcus, and thus requiring antibiotic therapy, is usually associated with a large number of streptococci in the cultures of that individual. However, in some clinical conditions where direct culture of the infected area is difficult, such as cervical adenitis and unruptured otitis media, a few streptococci may be significant. This is also true in patients with acute glomerular nephritis or rheumatic fever.

Advances in management of the nephrotic state.

The nephrotic state is a well-defined clinical entity without a generally accepted name. Nephrosis, lipemic or lipoid nephrosis, the nephrotic syndrome, and other names carry with them certain implications of etiology, pathology, or prognosis that are not justified in the present state of our very limited knowledge. For simplicity, the term nephrosis will be used to designate the syndrome of proteinuria, low serum albumin, high blood lipids, and variable edema. Forty-two patients, who have been studied and treated during the past three years, form the basis of the present report. One-half of the patients were 1 to 5 years old at the onset of edema. The age of the other patients varied evenly from 6 to 50 years. No effort was made to classify patients according to cause (glomerular nephritis or lipoid nephrosis). Although a respiratory infection often preceded the onset of nephrosis, the signs of acute glomerular nephritis were

OUTBREAK OF ACUTE NEPHRITIS IN ADOLESCENT SCHOOLBOYS

An outbreak of acute nephritis is reported which occurred among adolescent boys who were students at a private day school. Four boys in one class had clinically typical acute glomerular nephritis. Seventeen other members of this and one other class were found to have hematuria with or without associated albuminuria. The total incidence of hematuria among the 73 students in these two classes was 29%. Fifteen of the 21 boys with hematuria still had abnormally elevated Addis sediment counts approximately seven weeks after the initial examination. Cultures of the nasopharynx were made from 85 students. Hemolytic streptococci were detected in 11 (13%) of the boys including three with hematuria. The results of attempts to identify the streptococci by serologic technics indicated that at least five immunologically different varieties were represented. Determinations of antihyaluronidase, antistreptolysin "O" and antistreptokinase in serum from 17 boys with hematuria and 20 without apparent hematuria revealed wide variations in titer but no significant differences between the two groups.

Titers of heterophile antibodies and of antistreptolysin “O” in acute glomerular nephritis and in the nephrotic syndrome

Titers of heterophile antibodies and of antistreptolysin “O” in acute glomerular nephritis and in the nephrotic syndrome

Radioiodotherapeusis

A total of 111 patients have been treated with radioiodine; 106 had thyrotoxicosis; three had non-toxic nodular goiter and two had malignant adenoma. Six of the thyrotoxic subjects received their treatment too recently for adequate consideration. In ninety-two of ninety-seven patients treated with I 131 a remission was produced and has persisted. Most of these patients became euthyroid within six months, an average of approximately three months. A total of 222 doses of radioiodine were given to ninety-seven patients; an average of 2.2 doses per patient. Thirty-five required only one dose; fourteen were given more than three doses. In the group experiencing remissions within six months, approximately 225 μc. per Gm. of thyroid tissue were administered. An average total of about 8 mc. was required for thyrotoxic patients with diffuse hyperplasia of the thyroid and those previously thyroidectomized; twenty-two individuals with toxic nodular goiter required larger total doses although somewhat smaller in proportion to the size of the thyroid gland. The goiter was reduced in size in all instances. Indeed, in all except one of the patients with diffuse hyperplasia the gland decreased to an estimated 25 Gm. or less; the one exception was an individual who declined to return for completion of therapy. In most of the patients with diffuse hyperplasia the thyroid became reduced to essentially normal or subnormal size before remission resulted. Three patients developed persistent myxedema. In sixteen others transient hypothyroidism resulted. Three individuals with thyrotoxicosis were treated with I 130 with excellent results. In two patients with malignant adenoma the cervical masses became impalpable. Three subjects with non-toxic nodular goiter experienced only slight reduction in the size of the goiters. No significant untoward effects from the radioiodine were manifested by non-thyroid tissues. One individual was pregnant at the time of her therapy, one had acute glomerular nephritis, one had chronic pyelonephritis, three had had acute hepatitis and several had congestive heart failure. An outline of our present plan of therapy and a discussion of many factors concerned with iodotherapeusis are given in the following paper.

WHAT SHOULD THE GENERAL PRACTITIONER DO ABOUT ALLERGY?

There is a growing body of evidence that altered reactivity of the tissues on reexposure to certain substances is the causative factor in the production of several diseases the causation of which has been obscure, such as periarteritis nodosa, dermatomyositis, acute glomerular nephritis and others. However, it is the allergic manifestations which appear on the covering and lining membranes of the body, that is, the skin and the mucous membranes of the respiratory and gastrointestinal tracts, which present the day by day problems in practice. These include the eczemas of the infantile, atopic and contact types; urticaria; coryzas of the seasonal and perennial varieties; asthma, and some disturbances of the gastrointestinal tract which are usually functional in nature and in which the tissue changes are generally reversible. In uncomplicated cases, these allergic diseases seldom cause death, but their chronicity and the suffering and disability which they produce demand careful clinical

The Clinical and Prognostic Aspects of Acute Glomerular Nephritis.

The Clinical and Prognostic Aspects of Acute Glomerular Nephritis.

THE CAUSE OF CHRONIC NEPHRITIS

<h3>To the Editor:—</h3> In reading the paper on "Treatment of Acute Nephritis" by Drs. Francis D. Murphy and Bruno J. Peters (The Journal, January 17) we were surprised that mention was not made, in discussing the etiology, diagnosis, treatment and prognosis, of obstructing lesions in the ureter, at the vesical neck or in the urethra. It is difficult for a urologist to understand how it could be that some of the 205 patients in their study did not have an obstructing lesion which played a part in making the kidney vulnerable for the toxic agent that brought on the acute glomerular nephritis. Drs. Murphy and Peters say "Why some patients who have recovered from acute nephritis are completely healed and others progress gradually into the stage of chronic nephritis is an unsolved problem." Might not an obstructing lesion be at least one of the factors which caused 43 per cent

GLOMERULAR NEPHRITIS FOLLOWING INFECTIONS OF THE SKIN

While it is generally accepted that acute infection caused by streptococci precedes acute glomerular nephritis in the majority of cases, the exact course of events linking the infection with the renal disturbance is far from clear. Nor is it known whether once the nephritis has manifested itself, chronic infection remains an important agent in prolonging the disease. Authorities differ in the relative emphasis they place on the role of infection in this respect. Among protagonists of the etiologic importance of foci of infection is Kollert,1who distinguished two types of infection. One is the primary focus, a chronic, often long-standing obscure process, situated perhaps in a paranasal sinus, which renders the subject peculiarly reactive to the machinations of subsequent acute invasion by the same organism. In the latter, precipitating infection, the second of the two types, Kollert saw a trigger mechanism which sets off the initial attack of nephritis,

ACUTE EXPERIMENTAL GLOMERULAR NEPHRITIS IN RABBITS: A CORRELATION OF MORPHOLOGICAL AND FUNCTIONAL CHANGES

It has been shown in this paper that structural and functional changes in acute glomerular nephritis in rabbits produced by nephrotoxins by the method of Masugi are the same as those found in human glomerular nephritis. The morbid anatomy is characterized by glomerular cell proliferation, and in some cases by deposition of fibrin and crescent formation of the glomeruli and by fatty changes of the tubules. The functional changes are: oliguria, proteinuria, hematuria, cylindruria, edema, rise in blood urea, and according to Masugi (1933, 1934) and Smadel (1936, 1937), rise in blood pressure, lipuria, and fall in urea clearance and plasma proteins. As we are unaware of any discrepancies between the experimentally induced disease and human nephritis, the conclusion follows that the two so closely resemble each other that they appear to be identical. As to the pathogenesis, it has been shown that the disease begins with a period of latency. This is characterizied anatomically by hyperemia of the glomeruli; and functionally, in at least a number of cases, by an increased diuresis. It follows, therefore, that the theory of Volhard, according to which glomerular nephritis is caused by arteriolar spasms, can no longer be maintained. It has further been demonstrated that proliferation of glomerular cells is the typical lesion, and that deposition of fibrin and crescent formation occur only in certain cases, and in these only in a widely varying number of glomeruli. As crescents are found as early as the proliferation itself, it follows that they should not be regarded as pathognomonic of the subacute phase, but that they represent a complication which probably aggravates the disease. As to correlation of morphological and functional changes, it has been demonstrated that oliguria, marked proteinuria and diminished excretion of cyanol appear at the time when the glomerular changes are at their peak. Evidence has been presented that the oliguria and the decrease in cyanol excretion in acute glomerular nephritis are chiefly the result of the glomerular damage. It has further been demonstrated that the excretion of azofuchsin was unchanged, except for a diminution in the rabbit which at autopsy showed a marked fatty change of the tubules. We regard these observations as evidence, that, in acute glomerular nephritis in rabbits, glomeruli and tubules may function independently of each other.