Codys Leaky Glomeruli

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Codys Leaky Glomeruli

• Panel 8
• Question 1
• Aaron, Brady, Barbara, Steve

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Story Summary

• 4 year old Cody is diagnosed with strep throat
  and prescribed antibiotics. During a follow-up
  visit one week later, his doctor recognizes and
  investigates signs that indicate Cody has
  developed glomerulonephritis.

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Symptoms

• Visible blood in urine
• Decreased urine output
• Edema
• Common sites
• Face or eyes (most common)
• Feet, ankles, extremities
• Abdomen
• Cough with sputum
• Abnormal lab results of blood and urine
  (explained later)

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Diagnosis

• Post-streptococcal Glomerulonephritis (GN)
• Inflammation of the glomeruli following infection
  with certain strains of the streptococcus
  bacterium
• In Codys case (Group A Streptococcus)

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Pathophysiology

• Strep infection itself does not damage the
  kidneys
• Rather. . .
• Antibodies develop during succeeding weeks
  against the streptococcal antigen
• Antibodies and antigen react with each other to
  form an insoluble immune complex which becomes
  entrapped in the glomeruli
• Additionally, large s of WBCs become entrapped
  in the glomeruli
• Glomeruli become inflamed causing inefficient
  filtering and excreting function by the kidneys
• Usually develops 1-2 weeks after throat infection
• Common in children

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Pathophysiology

• Many glomeruli become blocked by inflammatory
  reaction
• Those that are not blocked become excessively
  permeable, allowing protein and RBCs to leak
  from the glomerular capillaries into the
  glomerular filtrate
• Severe cases total renal shutdown

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The Kidney
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(No Transcript)
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Treatment Options Prognosis

• No specific treatment focus is to relieve
  symptoms
• Antibiotics
• Destroy any remaining strep
• Antihypertensive
• May be needed to control high BP edema
• Dietary salt restriction
• Keeps plasma volume down, therefore decreases BP
• Corticosteroids other anti-inflammatory
  medications
• Generally ineffective
• Prognosis
• Usually resolves spontaneously after several
  weeks to months

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Changes
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Renin-Angiotension System
Decreased arterial pressure
Renin released by the kidney
Angiotensinogen
Angiotensin I
ACE
Angiotensinase inactivates A II
Angiotensin II
Renal retention of Na via aldosterone secretion,
resulting in increased H2O
VC
Increased arterial pressure
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Analogy

• Freeway. . .