disease associated with pulmonary hemorrhage. It is strongly associated with cigarette smoking

to the basement membrane and initiates damage Goodpasture's syndrome - Anti-GBM disease associated with pulmonary hemorrhage. It is strongly associated with cigarette smoking, 6.Crescentic glomerulonephritis - results from proliferation of epithelial cells. It may occur particularly in SLE, anti-GBM disease and the vasculitides (Wegner's granulomatosis and microscopic polyarteritis), but often occurs in absence of underlying disease. This pathological term is used synonymously with classical term 'rapidly progressive glomerulonephritis'. Investigations in glomerular disease; Baseline measurements 1 Glomerular filtration 2.24-hr protein excretion 3. Plasma albumin and creatinine Diagnostically important tests: 1. Urine - RBC casts indicate glomerular disease 2. Anti-DNA antibodies - positive in SL E 3. Antinuclear factor - positive in SLE 4. Blood glucose - excludes diabetes 5. CXR - detects pulmonary oedema, malignancy, pulmonary hemorrhage, cavitation in Wegner's granulomatosis. 6. Hepatitis B antigen - excludes hepatitis B 7. Rheumatoid factor - positive in RA 8. Serum and urine electrophoresis -excludes paraprotein 9. Anti-neutrophil cytoplasmic antibodies - positive in most cases of microscopic polyarteritis and Wegner's granulomatosis 10. Anti-glomerular basement membrane antibodies -Diagnostic of antiglomerular basement membrane disease 11 Serological tests for syphilis - excludes syphilis Clinical manifestations ACUTE NEPHRITIC SYNDROME Definition - A disease most common in children, characterised pathologically by diffuse inflammatory changes in the glomeruli and clinically by usually abrupt onset of macroscopic hematuria, proteinuria (usually moderate), oedema, hypertension and impaired renal function with or without oliguria. Not all features may be present at the same time Causes -1. Infective agents - (a) Viral- Hepatitis, HIV, mumps, echovirus, varicella, cytomegalovirus, (b) Bacterial - Hemolyic streptococcus, pneumococcus, klebsiella, staphylococcus spp , salmonella, brucella, gonococcus, yersinia, syphilis, tuberculosis, leprosy (c) Parasitic - Malaria, filaria, schistosomiasis, mycoplasma 2. Multisystem diseases - SLE, polyarteritis, Henoch-Schonlein purpura, Goodpasteur's syndrome, hemolyticuremic syndrome. 3. Primary glomerular disease -Membranoproliferative glomerulonephritis, Berger's disease, mesangial proliferative glomerulonephritis 4. Miscellaneous - Acute inflammatory demyelinating polyneuropathy, serum sickness, irradiation of Wilm's tumour Clinical features - Modes of onset - (a) Oedema - puffiness of face. (b) Urinary symptoms - Scanty and smoky or franky bloody urine. (c) Symptoms of acute infection - Fever, bodyache, vomiting. (d) Cerebral symptoms - Headache, convulsions. (e) Insidious onset - Weakness, pallor, loss of appetite. (f) Accidental discovery - on routine urine examination SYMPTOMS AND SIGNS - 1 Oedema - may come on suddenly or gradually Puffiness of face and whitish pallor constitute "nephritic fades", swelling of face usually in morning Generalised anasarca may occur. Oedema may be absent in mild cases and also in very severe cases. 2. Hypertension - occurs in majority of cases, the diastolic pressure being 90 to 120 mm usually, and as a rule persists for at least one week, returning to normal a few days after patient has had diuresis. In 5 to 10 per cent cases hypertensive encephalopathy