**Acute Glomerulonephritis (AGN) – In-depth Knowledge**

1. Glomerular Filtration Rate (GFR) Calculation:

• GFR is the amount of blood filtered by the glomeruli per minute, reflecting the function of the kidneys.

• Cockcroft-Gault Formula:

• GFR (ml/min) = (140 – age) x weight (kg) / (72 x serum creatinine (mg/dL)) x 0.85 (if female)

• Note:

• This formula is only applicable to adults.

• The GFR results should be interpreted by a doctor.

2. Urine Volume Calculation:

• Urine weight method:

• Weigh the urine volume over 24 hours, the result is the urine volume.

• Measurement using tools:

• Use specialized tools such as graduated cylinders, urine measuring cups, etc.

• Estimation method:

• Based on the number of urination times and estimate the urine volume each time.

3. Characteristics of Children’s Urine Composition:

• Children’s urine is usually lighter than adults’: due to the incomplete development of children’s kidneys, their ability to concentrate urine is limited.

• The amount of protein in children’s urine is lower: due to the incomplete filtration function of the glomeruli.

• Creatinine concentration in children’s urine is lower: due to the incomplete maturity of the children’s bodies.

• There may be a small amount of glucose in the urine: due to the limited ability of children’s kidneys to reabsorb glucose.

4. Causes of AGN:

a. Bacteria:

• Group A beta-hemolytic streptococcus: is the most common cause of AGN.

• Upper respiratory tract infections (URTIs): Types 1, 2, 4, 12, 18, 25.

• Skin infections: Types 49, 55, 57, 60.

• Other bacteria:

• Streptococcus pneumoniae, Staphylococcus aureus, Pneumococcus…

• Bacteria causing urinary tract infections – sexually transmitted diseases such as E.coli, Klebsiella, Proteus…

b. Viruses:

• Influenza virus: Causes AGN in children and adults.

• Epstein-Barr virus: Causes AGN in children and adults, commonly seen in patients with infectious mononucleosis.

• Cytomegalovirus: Causes AGN in children and adults, especially dangerous in immunocompromised individuals.

• Hepatitis B virus: Causes AGN in adults.

• HIV: Causes AGN in adults, commonly seen in immunocompromised individuals.

• Varicella-zoster virus: Causes AGN in children, rarely seen in adults.

• Measles virus: Causes AGN in children, rarely seen in adults.

• Adenovirus: Causes AGN in children, rarely seen in adults.

c. Parasites:

• Giardia lamblia: Causes AGN in children, rarely seen in adults.

• Strongyloides stercoralis: Causes AGN in children, rarely seen in adults.

• Schistosoma haematobium: Causes AGN in children, rarely seen in adults.

d. Fungi:

• Coccidioides immitis: Causes AGN in adults, rarely seen in children.

5. Glomerular Triad:

• Edema: Due to fluid accumulation in the tissues, commonly seen in the face, ankles, and feet.

• Hematuria: Due to glomerular damage, allowing red blood cells to leak into the urine, making the urine red or pink.

• Hypertension (HTN): Due to glomerular damage, causing dysfunction in blood pressure regulation, leading to increased blood pressure.

6. Age Groups Prone to AGN:

• AGN is commonly seen in children aged 5-12.

7. AGN Onset After:

• ENT infections: After 7-15 days.

• Skin infections: After 3-6 weeks.

8. Characteristics of the Glomerular Triad:

• Edema: Edema usually appears in the face, ankles, and feet, and can spread throughout the body.

• Hematuria: Hematuria is usually red or pink, sometimes brown-red, the amount of blood in the urine can vary depending on the severity of glomerular damage.

• HTN: HTN usually appears later than edema and hematuria, and can be mild or severe depending on the severity of glomerular damage.

9. Clinical Manifestations of AGN:

• Typical AGN: Includes all three main symptoms: edema, hematuria, and HTN.

• Asymptomatic AGN: No obvious symptoms, often discovered by chance during urine tests.

• Edematous AGN: Only has edema symptoms.

• Hematuria AGN: Only has hematuria symptoms.

• Hypertension AGN: Only has HTN symptoms.

• Acute renal failure AGN: Severe glomerular damage, leading to acute renal failure.

• Chronic progressive AGN: Glomerular damage is not treated promptly, leading to chronic renal failure.

10. Diagnosis of AGN:

• Clinical: Based on clinical symptoms and medical history.

• Urine tests: Detects protein, red blood cells, and casts in the urine.

• Blood tests: Detects changes in kidney function, inflammation.

• Kidney ultrasound: Evaluates the morphology of the kidneys, kidney size, detects structural abnormalities in the kidneys.

• Kidney biopsy: Evaluates the extent of glomerular damage, helps determine the cause of the disease and establish an appropriate treatment plan.

11. Treatment of AGN:

• Treatment of the cause: Treat the underlying cause of the disease such as bacterial, viral, parasitic, or fungal infections.

• Symptom management:

• HTN: Use antihypertensive drugs.

• Edema: Limit salt intake, use diuretics.

• Hematuria: Blood transfusions, fluid administration, use of hemostatic drugs.

• Supportive treatment: Rest, adequate nutrition.

12. Complications of AGN:

• Acute renal failure: Severe glomerular damage, leading to impaired kidney function.

• Chronic renal failure: Progressive glomerular damage, leading to chronic renal failure.

• Chronic hypertension: HTN is not controlled, leading to chronic hypertension.

• Heart failure: Due to fluid accumulation in the lungs, causing shortness of breath, heart failure.

• Anemia: Due to blood loss through urine.

• Electrolyte disturbance: Due to electrolyte imbalance in the body.

• Infection: Due to weakened immunity.

13. Prevention of AGN:

• Personal hygiene: Wash hands frequently with soap, avoid contact with sick people.

• Limit contact with sources of infection: Avoid contact with sick people, avoid contact with contaminated environments.

• Drink plenty of water: Helps eliminate toxins, reduces the risk of infection.

• Eat a healthy diet: Get adequate nutrition, avoid eating too much salt and sweets.

• Regular health check-ups: Early detection of the disease helps timely treatment.

14. Notes:

• AGN is a serious disease that can lead to chronic renal failure.

• See a doctor early for diagnosis and timely treatment.

• Follow the doctor’s treatment plan, do not self-medicate.

• Monitor your health regularly after recovery.

• AGN can leave behind sequelae later on, so maintain a healthy diet and lifestyle to protect your health.

15. Conditions That May Be Confused With AGN:

• Berger’s disease (IgA nephropathy): Is a type of chronic glomerulonephritis with similar clinical manifestations to AGN, but usually has more hematuria.

• Alport syndrome: Is a genetic disease with similar clinical manifestations to AGN, but usually has hematuria, deafness, and retinopathy.

• Benign familial hematuria: Is a genetic disease, often with mild hematuria, without edema and HTN.

• Other causes: Kidney tumors, kidney stones, kidney malformations, Endoxan drugs…

16. Kidney Biopsy:

• At the onset of the disease: Evaluate the severity of the disease, detect extracapillary proliferation.

• Late stage: Differentiate AGN from other diseases such as membranoproliferative glomerulonephritis, Lupus…

17. Hemodialysis:

• Hemodialysis is indicated in cases of acute renal failure, chronic renal failure.

• Hemodialysis helps remove waste products and toxins from the blood, regulate water and electrolyte levels in the body.

• Hemodialysis can be performed at home or in a hospital.

• Hemodialysis helps prolong the lifespan of patients, improve the quality of life.

18. Summary:

• AGN is a serious condition that can cause renal failure.

• Causes of the disease are diverse: bacteria, viruses, parasites, fungi.

• Typical symptoms: Edema, hematuria, HTN.

• Treatment of AGN: Treatment of the cause, symptom management, supportive treatment.

• Prevention of AGN: Personal hygiene, limit contact with sources of infection, drink plenty of water, eat a healthy diet, regular health check-ups.

Remember that this is just a translation, and it’s important to consult with a doctor for proper diagnosis and treatment.