) Renal or urinary tract pain occasionally as a result ol clot cole (f) Arthritis occurs rarely and suggests multisyamtemdsease Managamant • 1 Rest in

) Renal or urinary tract pain occasionally as a result ol clot cole (f) Arthritis occurs rarely and suggests multisyamtemdsease Managamant • 1 Rest in bad - diminishes risk of pulmonary oedama and hypertensive crises in a mid caser 3 weeks. In more severe cases it musi ai least 3 months Persistence of microscopic haemaluria, or proteinuria under 1 gm/day does not justify prolonged bed rast Patient should be allowed to be up and aboul once urinary findings have become stationary Bowels should be kept open 2 Restricted fluids - (Fruit juices contain potassium, and should be used wllh caution in oliguri patients) First 24-28 hours only 500 ml of water and glucose or barley water. Alter that if urine volume in 24 hours is less than 400 ml treat as for acute renal failure if urine volume is more than 400 ml limil intake of fluid to 500ml plus a volume equal to that passed in preceding 24 hours, low sad, low protein diet can be started 3 Diet - Low protein dial if patient is oedernatous or has engorged neck veins, the diet should contain very little sodum 4 Antilbiotics - Benzathine panicillin G 500.000 units IM 6-hourly to destroy any residual hemolytic streptococci Erythromycin 250 mg q ds H penicillin is not tolerated 5 Management of complications - (i) Convulsions -IV Diazepam 10 mg sbwty, if fils recur phenytoin sodum 100 mg b d IM (iii) Cardrac failure -Salt and water restrction Digitalis and frusemide Hypotensive drugs when there is considerable rise ol pressure associated (iii) Acute renal failure - See renal failure 6 DialvsJs -1 unconscious, twllchlng or deterlararing paiigni, rapldy rising blood urea or rising serum potassium In children peritoneal dialysis b preferred lo haamcdalyS'S 2 RAPIDLY PROGRESSIVE GLOMERULONEPHPITlS tHPGNI . DEFINITION - A ayndrnme charactersed by focal and segmenial necrosis and crescents inmost glomeiull and cllnCaBy by lulrnlnam renal lalfure assoclaiedwlih protelnuna, hematuria and REC casts CAUSES - 1. Primary renal disease - Idopathic, immune complex, Anti-GBM nephrits 2 Secondary extraranal disease - (a) Infectiona - PSON, infective endocarditis, shunt nephritis, visceralsepsis.hepatitis. (b) Multisystem disease -SLE". Henoch-Schonlem purpura. Wegner's granulomatosis. polyartenitis nodosa, dissemnaied intravascular coagulation. acceleraed hypertension clinical FEATURES - Hypertension, oedema, proteinuria and microscopic haematuria continue till the patient dies of renal failure or hypertension in 6-18 months alter initial attack Death from uremia occurs In about 11/2-2 years of onset TREATMENT - Plasma exchange (2-4 litres of plasmaphsrcsis daily) combined wth cortcosieroids and cyclophoaphamide in patirents with dllfuse crescentic glomerulonephrts Also anticoagulanis, like heparln and warfann and antUhforrboiiC agenl such as dipyndamole because ol involuement of coagulation process in crescent formation 3 GHRONJC GLOMERJLONEPHRJTIS CLNICAL FEATURES [a) Persistent proteinuria - Alter an apparent recovery from attfack of acute nephrtils or asympiomatic; protetnurla discovered at routine examination Alter a variabla period of upto 20 years, hypertennsion and renal failure supervene