7/23/2019 Renal Prep (1)

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Nancy Diaz

Prep questions- Renal

1. What are the pathophysiologic changes in acute streptococcal

glomerulonephritis?Antibody-antigen complees become lodged in the glomeruli! leading

to in"ammation and obstruction. #he glomerular membranes are

thic$ened and capillaries in the glomeruli are obstructed by damaged

tissue cells! leading to a decreased glomerular %ltration rate. &ascular

permeability increases! allo'ing protein! red blood cells! and red cast

to be ecreted. (odium and 'ater are retained! epanding the

intra)ascular and intestinal compartments and resulting in the

characteristic %nding o* edema.

+. What is the relationship bet'een group A streptococcal in*ection and

glomerulonephritis? #he child 'ith acute post in*ection glomerulonephritis ,APN/ usually

becomes ill a*ter contracting a nephrogenetic strain o* group A beta-

hemolytic streptococcal in*ection o* the upper respiratory tract or the

s$in. 0*ten the child contracts strep throat! reco)ers! and then

de)elops signs o* APN a*ter an inter)al o* 1-+1 days. lomerular

damage occurs as a result o* an immune comple reaction that

localizes on the glomerular capillary 'all.

2. 3o' is acute streptococcal glomerulonephritis diagnosed? #he serum 45N and 6r concentrations are ele)ated. (erum protein is

decreased ,hypoalbuminemia/ due to mild to moderate proteinuria.

W46 and erythrocyte sedimentation rate may be ele)ated. An

ele)ated antistreptolysin 0 ,A(0/ titer re"ects the presence o*

antibodies *rom a recent pharyngeal streptococcal respiratory

in*ection! A(0 le)el associated 'ith s$in in*ection is lo'. #he anti-

DNAase 4 titer is help*ul *or detecting antibodies associated 'ith

recent s$in in*ections. 7ost children ha)e a reduced serum

complement ,62/ le)el due to the initial in*ection.5rinalysis re)eals hematuria! proteinuria! and red and 'hite cell cast.

Anemia is common in the acute phase! usually because etracellular

"uid dilutes the serum. 3gb and 3ct le)els re)eal anemia! 'hich iscommon in the acute phase and is generally caused by dilution o* the

serum by the etracellular "uid.