Typical pattern is diffuse proliferative

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TYPICAL PATTERN IS:- - DIFFUSE PROLIFERATIVE GLOMERULONEPHRITIS. - FOCAL NECROTIZING LESION AND CRESCENTS IN > 50% OF GLOMERULI. IMMUNOFLORESCENCE REVEALS LINEAR DEPOSITION. X-RAY:- DIFFUSE B/L PULMONARY INFILTRATES ANCA:- ANCA IS TYPICALLY NEGATIVE (ANCA CAN OCCUR IN 30% CASES OF GOODPASTURE SYNDROME) 173
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TREATMENT:- PLASMAPHERESIS IS PERFORMED DAILY OR ON ALTERNATE DAYS. (THIS REMOVES EXISTING ANTIBODIES). CORTICOSTEROID IS STARTED SIMULTANEOUSLY IN COMBINATION WITH EITHER AZATHIOPRINE TO STOP THE PRODUCTION OF NEW ANTIBODIES. 174
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POSTSTREPTOCOCCAL GLOMERULONEPHRITIS TRUE ABOUT POST-STREPTOCOCCAL GLOMERULONEPHRITIS IS - (AI 2000) A) 50% OF CASES OCCUR AFTER PHARYNGITIS B) EARLY TREATMENT OF PHARYNGITIS ELIMINATES THE RISK OF P.S.GN. C) GLOMERULONEPHRITIS, SECONDARY TO SKIN INFECTION, IS MORE COMMON IN SUMMER D) RECURRENCE IS SEEN 175
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ACUTE POST STREPTOCOCCAL GLOMERULONEPHRITIS - FOLLOWS INFECTION OF THE THROAT OR SKIN BY CERTAIN NEPHRITOGENIC STRAINS OF BETA HEMOLYTIC STREPTOCOCCAL INFECTION. CASES OF GLOMERULONEPHRITIS FOLLOWING THROAT INFECTION PEAK DURING WINTER MONTHS AND MOST COMMONLY OCCUR DUE TO SEROTYPE 12. CASES OF GLOMERULONEPHRITIS FOLLOWING SKIN INFECTION - - PEAK DURING SUMMER MONTHS AND MOST COMMONLY OCCUR DUE TO INFECTION BY SEROTYPE 49. 176
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PATHOLOGY OF ACUTE POST STREPTOCOCCAL GLOMERULONEPHRITIS 177
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CLINICAL MANIFESTATION:- MOST COMMON IN CHILDREN AGED 5-12 YEARS. NEPHRITIC SYNDROME DEVELOPS 1-2 WEEK AFTER STREPTOCOCCAL THROAT INFECTION AND 3-60 WEEKS AFTER STREPTOCOCCAL SKIN INFECTION (PYODERMA). THE PATIENT PRESENTS CLASSICALLY WITH ACUTE NEPHRITIC SYNDROME CHARACTERIZED BY SUDDEN ONSET OF: - GROSS HEMATURIA - EDEMA - HYPERTENSION - RENAL INSUFFICIENCY . THE ACUTE PHASE GENERALLY RESOLVES WITHIN 6-80 WEEKS. 178
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179
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TREATMENT:- MANAGEMENT IS DIRECTED AT TREATING THE ACUTE EFFECT OF RENAL INSUFFICIENCY AND HYPERTENSION. 10 DAY COURSE OF SYSTEMIC ANTIBIOTIC (ALTHOUGH RECOMMENDED, IT DOES NOT AFFECT THE NATURAL COURSE OF THE DISEASE). PROGNOSIS:- COMPLETE RECOVERY OCCUR IN MORE THAN 95% OF CHILDREN. RECURRENCES ARE RARE. PREVENTION:- EARLY SYSTEMIC ANTIBIOTIC THERAPY FOR STREPTOCOCCAL THROAT AND SKIN INFECTION DOES NOT ELIMINATE THE RISK OF GLOMERULONEPHRITIS. 180
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TRUE ABOUT POST-STREPTOCOCCAL GLOMERULONEPHRITIS IS (AI 2000) A) 50% OF CASES OCCUR AFTER PHARYNGITIS B) EARLY TREATMENT OF PHARYNGITIS ELIMINATES THE RISK OF P.S.GN. C) GLOMERULONEPHRITIS, SECONDARY TO SKIN INFECTION, IS MORE COMMON IN SUMMER D) RECURRENCE IS SEEN ANS. IS ‘C’ I.E., GLOMERULONEPHRITIS SECONDARY TO SKIN INFECTION IS 181
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IGA NEPHROPATHY IGA-NEPHROPATHY IS SEEN IN – (AIIMS JUNE 2000) A) MEMBRANOUS GLOMERULONEPHRITIS B) MESANGIOPROLIFERATIVE GLOMERULONEPHRTIS C) FOCAL GLOMERULONEPHRITIS D) CRESENTIC GLOMERULONEPHRITIS 182
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“IGA NEPHROPATHY IS A TYPE OF MESANGIOPROLIFERATIVE GLOMERULONEPHRITIS”.
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