Acute proliferative glomerulonephritis
Acute proliferative glomerulonephritis is a disorder of the glomeruli, or small blood vessels in the kidneys. It is a common complication of bacterial infections skin infection by Streptococcus bacteria types 12, 4 and 1 but after streptococcal pharyngitis, for which it is known as postinfectious or poststreptococcal glomerulonephritis, it can be a risk factor for future albuminuria. In adults, the signs and symptoms of infection may still be present at the time when the kidney problems develop, the terms infection-related glomerulonephritis or bacterial infection-related glomerulonephritis are used. Acute glomerulonephritis resulted in 19,000 deaths in 2013 down from 24,000 deaths in 1990 worldwide. Among the signs and symptoms of acute proliferative glomerulonephritis are the following: Hematuria Oliguria Edema Hypertension Fever Acute proliferative glomerulonephritis is caused by an infection with streptococcus bacteria three weeks after infection of the pharynx or the skin, given the time required to raise antibodies and complement proteins.
The infection causes blood vessels in the kidneys to develop inflammation, this hampers the renal organs ability to filter urine. Acute proliferative glomerulonephritis most occurs in children; the pathophysiology of this disorder is consistent with an immune-complex-mediated mechanism, a type III hypersensitivity reaction. This disorder produces proteins that have different antigenic determinants, which in turn have an affinity for sites in the glomerulus; as soon as binding occurs to the glomerulus, via interaction with properdin, the complement is activated. Complement fixation causes the generation of additional inflammatory mediatorsComplement activation is important in acute proliferative glomerulonephritis. Immunoglobulin -binding proteins bind C4BP. Complement regulatory proteins, may be removed by SpeB, therefore restrain FH and FHL-1 recruitment in the process of infection; the following diagnostic methods can be used for acute proliferative glomerulonephritis: Kidney biopsy Complement profile Imaging studies Blood chemistry studiesClinically, acute proliferative glomerulonephritis is diagnosed following a differential diagnosis between staphylococcal and streptococcal impetigo.
Serologically, diagnostic markers can be tested. The differential diagnosis of acute proliferative glomerulonephritisis is based on the following: It is unclear whether or not acute proliferative glomerulonephritis can be prevented with early prophylactic antibiotic therapy, with some authorities arguing that antibiotics can prevent development of acute proliferative glomerulonephritis, while others reject that antibiotics can prevent acute proliferative glomerulonephritis. Acute management of acute proliferative glomerulonephritis consists of blood pressure control. A low-sodium diet may be instituted. In individuals with oliguric acute kidney injury, the potassium level should be controlled. Thiazide or loop diuretics can be used to reduce edema and control hypertension. Beta-blockers, Calcium channel blockers, and/or ACE inhibitors may be added if blood pressure is not controlled through diureses alone. Acute glomerulonephritis resulted in 19,000 deaths in 2013 down from 24,000 deaths in 1990.
Group A Streptococcal Infections - National Institute of Allergy and Infectious Diseases Wilkins, Lippincott Williams &. Rapid Assessment: A Flowchart Guide to Evaluating Signs and Symptoms. Lippincott Williams & Wilkins. ISBN 9781582552729
Vasculitis is a group of disorders that destroy blood vessels by inflammation. Both arteries and veins are affected. Lymphangitis is sometimes considered a type of vasculitis. Vasculitis is caused by leukocyte migration and resultant damage. Although both occur in vasculitis, inflammation of veins or arteries on their own are separate entities. Possible symptoms include: General symptoms: Fever, weight loss Skin: Palpable purpura, livedo reticularis Muscles and joints: Myalgia or myositis, arthralgia or arthritis Nervous system: Mononeuritis multiplex, stroke, reduced visual acuity, acute visual loss Heart and arteries: Myocardial infarction, gangrene Respiratory tract: Nose bleeds, bloody cough, lung infiltrates GI tract: Abdominal pain, bloody stool, perforations Kidneys: Glomerulonephritis Vasculitis can be classified by the cause, the location, the type of vessel or the size of vessel. Underlying cause. For example, the cause of syphilitic aortitis is infectious However, the causes of many forms of vasculitis are poorly understood.
There is an immune component, but the trigger is not identified. In these cases, the antibody found is sometimes used in classification, as in ANCA-associated vasculitides. Location of the affected vessels. For example, ICD-10 classifies "vasculitis limited to skin" with skin conditions, "necrotizing vasculopathies" with musculoskeletal system and connective tissue conditions. Arteritis/phlebitis on their own are classified with circulatory conditions. Type or size of the blood vessels. Apart from the arteritis/phlebitis distinction mentioned above, vasculitis is classified by the caliber of the vessel affected. However, there can be some variation in the size of the vessels affected. A small number have been shown to have a genetic basis; these include adenosine deaminase 2 deficiency and haploinsufficiency of A20 According to the size of the vessel affected, vasculitis can be classified into: Large vessel: Takayasu's arteritis, Temporal arteritis Medium vessel: Buerger's disease, Kawasaki disease, Polyarteritis nodosa Small vessel: Behçet's syndrome, Eosinophilic granulomatosis with polyangiitis, Cutaneous vasculitis, granulomatosis with polyangiitis, Henoch–Schönlein purpura, microscopic polyangiitis.
Condition of some disorders have vasculitis as their main feature. The major types are given in the table below:Takayasu's arteritis, polyarteritis nodosa and giant cell arteritis involve arteries and are thus sometimes classed under arteritis. Furthermore, there are many conditions that have vasculitis as an accompanying or atypical feature, including: Rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis Cancer, such as lymphomas Infections, such as hepatitis C Exposure to chemicals and drugs, such as amphetamines and anthrax vaccines which contain the Anthrax Protective Antigen as the primary ingredient. In pediatric patients varicella inflammation may be followed by vasculitis of intracranial vessels; this condition is called post varicella angiopathy and this may be responsible for arterial ischaemic strokes in children. Several of these vasculitides are associated with antineutrophil cytoplasmic antibodies; these are: Granulomatosis with polyangiitis Eosinophilic granulomatosis with polyangiitis Microscopic polyangiitis Laboratory tests of blood or body fluids are performed for patients with active vasculitis.
Their results will show signs of inflammation in the body, such as increased erythrocyte sedimentation rate, elevated C-reactive protein, increased white blood cell count and eosinophilia. Other possible findings are hematuria. Other organ functional tests may be abnormal. Specific abnormalities depend on the degree of various organs involvement. A Brainspect can show decreased blood flow to the brain damage; the definite diagnosis of vasculitis is established after a biopsy of involved organ or tissue, such as skin, lung, nerve and kidney. The biopsy elucidates the pattern of blood vessel inflammation. An alternative to biopsy can be an angiogram, it can demonstrate characteristic patterns of inflammation in affected blood vessels. 18F-fluorodeoxyglucose positron emission tomography/computed tomography has become a used imaging tool in patients with suspected Large Vessel Vasculitis, due to the enhanced glucose metabolism of inflamed vessel walls. The combined evaluation of the intensity and the extension of FDG vessel uptake at diagnosis can predict the clinical course of the disease, separating patients with favourable or complicated progress.
Acute onset of vasculitis-like symptoms in small children or babies may instead be the life-threatening purpura fulminans associated with severe infection. In this table: ANA = Antinuclear antibodies, CRP = C-reactive protein, ESR = Erythrocyte Sedimentation Rate, dsDNA = double-stranded DNA, ENA = extractable nuclear antigens, RNP = ribonucleoproteins. Corticosteroids such as prednisone are used. Additionally, other immune suppression drugs, such as cyclophosphamide and others, are considered. In case of an infection, antimicrobial agents including cephalexin may be prescribed. Affected organs may require specif
Nephrology is a specialty of medicine and pediatrics that concerns itself with the kidneys: the study of normal kidney function and kidney disease, the preservation of kidney health, the treatment of kidney disease, from diet and medication to renal replacement therapy. Nephrology studies systemic conditions that affect the kidneys, such as diabetes and autoimmune disease. A physician who has undertaken additional training and become certified in nephrology is called a nephrologist; the term "nephrology" was first used in about 1960. Before the specialty was referred to as "kidney medicine." Nephrology concerns the diagnosis and treatment of kidney diseases, including electrolyte disturbances and hypertension, the care of those requiring renal replacement therapy, including dialysis and renal transplant patients. Many diseases affecting the kidney are systemic disorders not limited to the organ itself, may require special treatment. Examples include acquired conditions such as systemic vasculitides and autoimmune diseases, as well as congenital or genetic conditions such as polycystic kidney disease.
Patients are referred to nephrology specialists after a urinalysis, for various reasons, such as acute kidney failure, chronic kidney disease, proteinuria, kidney stones and disorders of acid/base or electrolytes. A nephrologist is a physician who specializes in the treatment of kidney disease. Nephrology requires additional training to become an expert with advanced skills. Nephrologists may provide care to people without kidney problems and may work in general/internal medicine, transplant medicine, immunosuppression management, intensive care medicine, clinical pharmacology, perioperative medicine, or pediatric nephrology. Nephrologists may further sub-specialise in dialysis, kidney transplantation, chronic kidney disease, cancer-related kidney diseases, procedural nephrology or other non-nephrology areas as described above. Procedures a nephrologist may perform include native kidney and transplant kidney biopsy, dialysis access insertion, fistula management, bone biopsy. Nephrology training in Australia and New Zealand includes completion of a medical degree, Basic Physician Training, successful completion of the Royal Australasian College of Physicians written and clinical examinations, Advanced Physician Training in Nephrology.
The training pathway is accredited by the Royal Australasian College of Physicians. Nephrologists may additionally complete of a post-graduate degree in a nephrology research interest. All Australian and New Zealand nephrologists participate in career-long professional and personal development through the Royal Australasian College of Physicians and other bodies such as the Australian and New Zealand Society of Nephrology and the Transplant Society of Australia and New Zealand. In the United Kingdom, nephrology is a subspecialty of general medicine. A nephrologist has completed medical school, foundation year posts and core medical training and passed the Membership of the Royal College of Physicians exam before competing for a National Training Number in renal medicine; the typical subspecialty training is five years and leads to a Certificate of Completion of Training in both renal medicine and general medicine. Subspecialty trainees interrupt their clinical training to obtain research degrees.
Nephrology training can be accomplished through one of two routes. The first pathway is through an internal medicine pathway leading to an Internal Medicine/Nephrology specialty, sometimes known as "adult nephrology"; the second pathway is through Pediatrics leading to a speciality in Pediatric Nephrology. In the United States, after medical school adult nephrologists complete a three-year residency in internal medicine followed by a two-year fellowship in nephrology. Complementary to an adult nephrologist, a pediatric nephrologist will complete a three-year pediatric residency after medical school or a four-year Combined Internal Medicine and Pediatrics residency; this is followed by a three-year fellowship in Pediatic Nephrology. Once training is satisfactorily completed, the physician is eligible to take the American Board of Internal Medicine or American Osteopathic Board of Internal Medicine nephrology examination. Nephrologists must be approved by one of these boards. To be approved, the physician must fulfill the requirements for education and training in nephrology in order to qualify to take the board's examination.
If a physician passes the examination he or she can become a nephrology specialist. Nephrologists need two to three years of training in an ACGME or AOA accredited fellowship in nephrology. Nearly all programs train nephrologists in continuous renal replacement therapy. Only pediatric trained physicians are able to train in pediatric nephrology, internal medicine trained physicians may enter general nephrology fellowships. History and physical examination are central to the diagnostic workup in nephrology; the history inc
Digital object identifier
In computing, a Digital Object Identifier or DOI is a persistent identifier or handle used to identify objects uniquely, standardized by the International Organization for Standardization. An implementation of the Handle System, DOIs are in wide use to identify academic and government information, such as journal articles, research reports and data sets, official publications though they have been used to identify other types of information resources, such as commercial videos. A DOI aims to be "resolvable" to some form of access to the information object to which the DOI refers; this is achieved by binding the DOI to metadata about the object, such as a URL, indicating where the object can be found. Thus, by being actionable and interoperable, a DOI differs from identifiers such as ISBNs and ISRCs which aim only to identify their referents uniquely; the DOI system uses the indecs Content Model for representing metadata. The DOI for a document remains fixed over the lifetime of the document, whereas its location and other metadata may change.
Referring to an online document by its DOI is supposed to provide a more stable link than using its URL. But every time a URL changes, the publisher has to update the metadata for the DOI to link to the new URL, it is the publisher's responsibility to update the DOI database. If they fail to do so, the DOI resolves to a dead link leaving the DOI useless; the developer and administrator of the DOI system is the International DOI Foundation, which introduced it in 2000. Organizations that meet the contractual obligations of the DOI system and are willing to pay to become a member of the system can assign DOIs; the DOI system is implemented through a federation of registration agencies coordinated by the IDF. By late April 2011 more than 50 million DOI names had been assigned by some 4,000 organizations, by April 2013 this number had grown to 85 million DOI names assigned through 9,500 organizations. A DOI is a type of Handle System handle, which takes the form of a character string divided into two parts, a prefix and a suffix, separated by a slash.
Prefix/suffixThe prefix identifies the registrant of the identifier, the suffix is chosen by the registrant and identifies the specific object associated with that DOI. Most legal Unicode characters are allowed in these strings, which are interpreted in a case-insensitive manner; the prefix takes the form 10. NNNN, where NNNN is a series of at least 4 numbers greater than or equal to 1000, whose limit depends only on the total number of registrants; the prefix may be further subdivided with periods, like 10. NNNN. N. For example, in the DOI name 10.1000/182, the prefix is 10.1000 and the suffix is 182. The "10." Part of the prefix distinguishes the handle as part of the DOI namespace, as opposed to some other Handle System namespace, the characters 1000 in the prefix identify the registrant. 182 is item ID, identifying a single object. DOI names can identify creative works in both electronic and physical forms and abstract works such as licenses, parties to a transaction, etc; the names can refer to objects at varying levels of detail: thus DOI names can identify a journal, an individual issue of a journal, an individual article in the journal, or a single table in that article.
The choice of level of detail is left to the assigner, but in the DOI system it must be declared as part of the metadata, associated with a DOI name, using a data dictionary based on the indecs Content Model. The official DOI Handbook explicitly states that DOIs should display on screens and in print in the format doi:10.1000/182. Contrary to the DOI Handbook, CrossRef, a major DOI registration agency, recommends displaying a URL instead of the specified format This URL is persistent, so it is a PURL — providing the location of an HTTP proxy server which will redirect web accesses to the correct online location of the linked item; the CrossRef recommendation is based on the assumption that the DOI is being displayed without being hyperlinked to its appropriate URL – the argument being that without the hyperlink it is not as easy to copy-and-paste the full URL to bring up the page for the DOI, thus the entire URL should be displayed, allowing people viewing the page containing the DOI to copy-and-paste the URL, by hand, into a new window/tab in their browser in order to go to the appropriate page for the document the DOI represents.
Major applications of the DOI system include: scholarly materials through CrossRef, a consortium of around 3,000 publishers. Research datasets through DataCite, a consortium of leading research libraries, technical information providers, scientific data centers. Permanent global identifiers for commercial video content through the Entertainment ID Registry known as EIDR. In the Organisation for Economic Co-operation and Development's publication service OECD iLibrary, each table or graph