[0:00]Hello friends, welcome to Rajneet Medical Education. Is lecture mein hum discuss karenge acute glomerulonephritis. So let's start the video. So, acute glomerulonephritis kya hota hai? Glomerulonephritis, ye kidney disorder hai. Kyunki jo glomerulus hai, vo kahan paya jata hai? Kidneys ke jo nephrons hai wahan par paya jata hai. To acute ka yahan par matlab kya hai? Acute bhi ho sakta hai glomerulonephritis. Chronic bhi ho sakta hai. Acute ka matlab hai ki jo suddenly condition arise hoti hai aur suddenly uske sign and symptom show hote hai. Chronic ka matlab hai chronic matlab agar long time se vo condition chali aa rahi hai to long term se chronic ka kya matlab hai yahan par ki jo sign and symptoms hai vo silent honge. Aur kafi lambe time se ye condition chali aaegi and then uske baad sign and symptom suddenly arise honge. To acute glomerulonephritis hum yahan par pad rahe hai. Chahe vo chronic glomerulonephritis hai, uske suddenly jo symptoms honge vo same acute jaise hi honge. Bas acute ka kya matlab hai ki suddenly vo condition arise hui hai. Acute ko hum cure bhi kar sakte hai. Lekin chronic ka matlab kya hota hai? Chronic ka matlab hota hai kafi lambe time se usko glomerulonephritis hai patient ko, jiski wajah se kya hota hai kidneys mein bahut jyada damage already ho jata hai, jisko cure karna mushkil hota hai. Fir uske liye symptomatic treatment hota hai. To hum pad rahe hai acute glomerulonephritis, jisko hum AGN bhi bolte hai. To glomerulonephritis ka kya matlab hai ki jo kidneys ka jo functional unit hai nephron, nephron ke andar kya hota hai? To ye kidneys hai. Kidneys mein kya hote hai? Nephron hote hai jo ki functional unit hai kidneys ke. Ab in nephron mein kya hota hai? Filtering system hota hai. Ab ye filtering system kya hai iska? Ye jo glomerulus hai. To ye is tarah se hota hai jaise ki ye Bowmans capsule hai. Iske andar bahut sare tiny capillaries hoti hai. Jo ki kya karti hai blood ko filter karti hai. Isko hum kya bolte hai? Isko hum bolte hai glomerulus. Aur jab is glomerulus mein ye jo tiny capillaries hai, agar inmein inflammation ho jati hai jisse kya hota hai ki blood ka filtration mein changes aa jate hai jo ki ye kya karti hai? Vaise blood ko filter karti hai. Jo bhi blood hai usko filter karegi usme se jo excess water hai, ions hai, jo bhi toxins hai blood mein vo remove karti hai nephron aur baki ki jo chize hai vo dobara se circulation mein vapas aa jati hai jaise ki jo blood cells hai, proteins hai, vo circulation mein vapas aa jate hai. Jabki jo bhi waste product hai, toxins hai, excess water hai vo remove ho jata hai filter ho jata hai in glomerulus ke through in the form of urine, urine ki form mein vo humari body se bahar chala jata hai. Jab is glomerulus mein inflammation ho jati hai tab hum usko kya bolte hai? Glomerulonephritis. Means ye jo filtering system hai ismein kya ho jati hai? Inflammation ho jati hai. Abhi hum padenge ki ismein ye kyun hoti hai inflammation. To AGN acute glomerulonephritis ek kidney disease hai that is characterized by the sudden onset of inflammation in the glomeruli. Kyunki ye acute hai isliye ismein kya dekhne ko milta hai ki suddenly ye jo glomerulus hai yahan par kya ho gayi hai? Inflammation ho gayi hai glomeruli mein. The inflammation can impair kidney function and may result from infections, autoimmune diseases or other causes. Ab ye kyun hoti hai inflammation? Dekho, ye yahan par jo common reason hai acute glomerulonephritis ka hone ka, vo kya hai? Infections, koi bhi infection jaise ki streptococcal infection, uske baad ye ho sakta hai aur bhi infections hum padenge. Uske karan kya hoti hai? Humari body koi bhi jo infection humari body mein jab ho jata hai, koi bhi foreign particle jab humari body mein enter hota hai, antigen enter hota hai, foreign koi bhi jo microorganism usko hum kya bolte hai? Antigen bolte hai. To jab bhi koi body mein antigen enter hota hai, uske baad body ka jo immune system hai uske liye react karta hai aur kya banata hai? Antibodies banata hai. Antibodies. To glomerulonephritis mein basically kya hota hai? Ki ye jo immune system hai vaise hi kya karta hai ki antigen par attack karta hai. Lekin is condition mein kya hota hai ki ye humari kidneys ko hi damage karne lag jata hai. Kya hota hai ki body mein antigen antibody complexes ban jate hai. Antigen antibody complexes ya fir inko immune complexes bol sakte hai. Ye jo complex hai ye ja kar yahan glomerulus mein wahan deposit ho jate hai. To kidney mein ja kar deposit ho jate hai. To ye kya hai? Yahan par ja kar deposit ho jate hai. Ye is tarah se ye antigen antibody complexes deposit ho gaye glomerulus mein. Jiski vajah se kya hota hai ki glomerulus mein inflammation ho jati hai. Inflammation ab ye jo part hai yahan par kya hai? Inflammation ho gayi hai jahan par bhi antigen antibody complexes ja kar deposit hue hai. Vo parts car ho gaya hai.
[4:58]Wahan par scarring ho gayi hai, damage ho gaya, inflammation ho gayi hai. Jis ke karan jo ye filtering mechanism hai ye jo glomerular capillaries hai ye acche se filter nahi kar pati blood ko. Ye kya ho jati hai? Incapable ho jati hai. Inmein kya ho jata hai bahut jyada damage ho jata hai jiski wajah se blood ko ye acche se filter nahi kar pati. Jaise ki jo excess water jana tha kidney se bahar, jo waste product jana tha kidney se bahar, vo properly kidney se bahar urine ke through body se nahi ja pata. Vo body mein hi ikattha hone lag jata hai waste product. Lekin aisi chize jaise ki protein aur jo blood cells hai jo ki hamare body mein hi rehne chahiye vo inflammation aur damage ke karan urine ke through leak hona start ho jate hai. To urine mein kya dikhega? Protein dikhega. Blood cells dikhenge, blood cells dikhenge jiski wajah se urine ka color kaisa hoga? Jaisa Coca-Cola hota hai, cola colored urine ismein dikhai deta hai. Coca-Cola color ka urine aata hai kyunki usmein blood cells present hai. Red blood cells present hai. Usmein protein present hoga jiski wajah se urine ka jo texture hai vo kaisa hoga? Foamy texture hoga. To overall kya hota hai glomerulonephritis mein ki hamara jo immune system hai vahi uske hi complexes deposit hone lag jate hai glomerulus mein. Kyun deposit hote hai vo? Kyunki koi infection hua tha jiski wajah se immune system trigger hua aur vo immune system trigger hone ke karan wahan par antigen antibody complexes deposit ho gaye jiski wajah se glomerulus damage ho gaya usmein inflammation ho gayi. Ab hum iski pathophysiology discuss karte hai to aapko aur clear ho jaega. To acute glomerulonephritis mein kya hota hai? Inflammation ho jati hai glomerulus mein jo ki kidney mein nephron ke andar paya jata hai, usually triggered by an immune response aur immune response se ye triggered hota hai jaise ki maine bataya. When antigens enter the body they stimulate an immune response, producing antibodies that can mistakenly target the kidneys glomeruli. Ismein kya hota hai ki mistakenly by mistake jo kidneys hai uske hi tissues ko target karta hai aur wahan par jaake deposit ho jate hai ye antibody antigen complex.
[7:10]To antigen antibody complexes kya hote hai? Ye immune complexes deposit ho jate hai glomeruli mein that results in inflammation, swelling and scarring of the glomerular capillaries reducing the kidney's ability to filter blood effectively. This leads to classic signs and symptoms associated with AGN, such as hematuria. Hematuria kya hai ki jo blood cells hai vo leak hona start ho jate hai. Protein leak hona start ho jate hai. Protein aur blood cells usually kya hote hai ki ye urine mein leak nahi hote. Lekin glomerulonephritis mein leak hona start ho jate hai. Yahan par jo protein urea hai, glomerulonephritis mein vo mild hoga as compared to nephrotic syndrome. Nephrotic syndrome mein aap hematuria nahi dekhenge. Wahan par blood cells nahi release hote urine mein. Wahan par jo protein urea hai vo bahut jyada excessive hota hai. Excessive protein urea wahan par dekhne ko milta hai. Lekin yahan par protein urea mild hoga aur hematuria hoga. Blood cells dekhne ko milenge urine mein, decreased urine output. Jo GFR hai, glomerular filtration rate, matlab ki jo kidneys jo filter kar rahi hai blood ko, uski vo ability reduce ho gayi hai. To kya hota hai ki glomerular filtration rate reduce ho jata hai jiski wajah se urine output bhi reduce ho jata hai. Next is causes. Ab aisa kyun hota hai? To maine aapko bataya usually ye infections ke karan hota hai aur sabse common infection kya hai? Streptococcal infection. Jisko hum kya bolte hai? Post streptococcal glomerulonephritis. Aur ye kaun sa streptococcus hai? Group A beta hemolytic streptococcus. Iski wajah se kya hota hai? Jab ye streptococcal infection ho gaya jaise ki koi bhi strep infection jaise ki throat ka ya fir skin mein strep infection hua uske baad uske 2-3 hafte baad ye dekhne ko milta hai. Kyun? Infection ek bar cure ho gaya lekin vo infection andar hi hai. Vo infection ke karan kya hua? Trigger ho gaya immune system aur vo immune system ne kya banaye? Antigen antibody complexes jo ki ja kar kahan par deposit ho gaye? Glomerulus mein deposit ho gaye. Ab ye jyada common kis mein dekhne ko milta hai? Children mein dekhne ko milta hai ki unko strep infection hua uske thode time baad kya hua? Ki glomerulonephritis ke sign and symptoms nazar aaye. To ye 2 se 10 saal ke bacho mein jyada dekhne ko milta hai. Ab streptococcal infection ke karan sabse commonly ho sakta hai. Uske baad aisa recently dekhne ko mila hai ki glomerulonephritis staphylococcal infection se bhi ho sakta hai. Jo staphylococcus aureus hai wo us infection se bhi ho sakta hai. Recently kya dekhne ko mila hai ki antibiotic resistance staphylococcus aureus ke jo infections ke jo cases hai vo increase ho gaye hai. Ki aisi staphylococcus aureus ki species jo aayi hai jo ki antibiotic se resistant hoti hai. Chahe antibiotic bhi de de tab bhi uska us par koi bhi asar nahi padta. To aise cases jyada aajkal dekhne ko mil rahe hai jiski wajah se glomerulonephritis ho raha hai. Uske baad koi bhi viral infection jaise ki hepatitis B, C, HIV, malaria, even pneumococcal infection se bhi ye ho sakta hai. Autoimmune condition se bhi ho sakta hai. Autoimmune conditions kya hoti hai ki humari immunity hamare hi cells ko jab attack karne lag jati hai usko autoimmune condition bolte hai. Ismein systemic lupus erythematosus ata hai SLE aur vasculitis. Vasculitis bhi kya hota hai ki blood vessels ki inflammation, vo bhi blood vessels capillaries ki inflammation. Ye bhi autoimmune condition hai. Iski wajah se jo glomerulus hai vo bhi kya hai? Blood capillaries hai. Wahan par bhi problem ho sakti hai. Then ata hai IgA nephropathy IgA nephropathy ya fir burgers disease isko bolte hai. Ismein kya hota hai ki jo IgA immunoglobulin hai uske complexes deposit ho jate hai. Ye bhi is tarah se kya hai ki immune complexes kiske? IgA immunoglobulins ke deposit hone ke karan wahan par glomerulus mein inflammation ho jati hai jis ke karan glomerulonephritis hota hai. Uske baad ata hai sign and symptoms. Ab sign and symptoms kya hai? Sabse pehle kyunki blood cells leak ho rahe hai urine mein jiski wajah se kya hoga? Hematuria hoga. Ab hematuria agar blood present hai urine mein to vo kaisa dikhta hai? Tea colored jaisa tea ka color hota hai ya fir jaise cola jo ki Coca-Cola hai us color ka urine dikhai deta hai. Uske baad protein ke leak hone ki wajah se kya hota hai? Foamy urine hota hai. Urine mein kya hota hai? Froth hota hai, foam hota hai. Protein ki presence ye indicate karta hai. Ab yahan par jo protein leak ho rahe hai urine mein usse bahut sari condition hoti hai body mein. Kyunki protein usually kya hai ki vo leak nahi hone chahiye. Vo hamare body mein hi rehne chahiye. Jab protein leak hone lag jate hai to proteins kaun kaun se hote hai jaise ki albumin. Albumin leak hona. To albumin kya karta hai? Blood vessels mein fluid ko maintain karke rakhta hai jis ko hum kya bolte hai? Oncotic pressure bolte hai. To albumin oncotic pressure ko maintain karke rakhta hai. Agar ye oncotic pressure ko maintain nahi karega to kya hoga ki ye jo fluid hai ye blood vessel se escape hoke nikal kar tissues mein aa jaega. Tissues mein aane ki wajah se kya hoga? Ki body mein fluid bhar jaega jis ko hum kya bolte hai? Edema bolte hai. To yahan par yahi hota hai glomerulonephritis mein ki protein ke leak hone ke karan urine mein protein leak ho gaya jis ke karan body mein protein ki kami hone ke karan specially albumin ki kami hone ke karan body mein edema dekhne ko milta hai. Aur ye edema around eyes, eyes ke around, face.
[12:37]Par dekhne ko milta hai, legs mein, ankles mein, feet mein dekhne ko milta hai. Then uske baad ata hai anemia. Anemia kyun ho sakta hai? Jab agar blood cells leak ho rahe hai urine mein to blood ki blood cells kam ho jayenge body mein jis ke karan kya hoga? Anemia ki condition ho sakti hai. Uske baad azotemia. Azotemia kya hai? Ki elevated serum creatinine and blood urea nitrogen. Jab kidneys filter nahi kar pati blood ko acche se to humari body mein nitrogenous waste accumulate hone lag jata hai. To waste to ja nahi raha blood se filter nahi ho raha. To usse kya hoga blood mein serum creatinine and blood urea nitrogen ka level increase ho jaega. Jis ko hum kya bolte hai? Azotemia bolte hai. Then ata hai decreased glomerular filtration rate. Kyunki filter nahi kar pa rahi kidneys acche se to GFR kya ho jaega? Reduce ho jaega. GFR reduce hona ka kya matlab hai simply? Ki urine output reduce ho jaega jis ko hum kya bolte hai? Oliguria bolte hai. Urine output kis se reduce hoga? Less than 400 ml per day, 400 ml per day se bhi kam urine matlab ek din mein 400 ml se bhi kam urine pass hoga aur less than 30 ml per hour hum bol sakte hai. Uske baad hypertension. Hypertension ka reason kya hai? Sabse pehle edema ho raha hai body mein. Fluid retention ho rahi hai jiski wajah se hypertension ho sakta hai. Fluid retention ka matlab hai ki sodium bhi retain ho raha hai to jiski wajah se blood pressure increase ho raha hai. Uske baad flank pain, kyunki kidneys mein kya hai? Inflammation hai to back side kya hoga? Pain hoga.
[14:04]Back mein pain hoga jis ko flank pain bolte hai kyunki kidneys mein inflammation hai. Uske baad complications kya aa sakti hai? Agar isko treat nahi kiya jata acute glomerulonephritis ko to ye kya ban sakta hai? Chronic kidney disease ban sakti hai, CKD ban sakti hai ya fir ultimately kya ho sakta hai? End stage renal failure ho sakta hai. Uske baad diagnose kaise karenge isko? Urinalysis, urine ko check karenge urine ka analysis karenge jis mein hum kya dekhte hai? Ki urine mein sabse pehle to protein ki presence hai. Blood cells ki present hai. Urine output less hai. To isko urinalysis kehte hai. Isse humein idea milega. Then increased ASO titer. ASO titer kya hota hai? Anti-streptolysin-O titer. Kyun? Streptococcal infection ki wajah se sabse common hai. To agar ye ASO titer ye positive aata hai means iske against antibodies bani hui hai to ye kya indicate karta hai ki strep infection ki wajah se glomerulonephritis ho sakta hai. Uske baad elevated serum creatinine and BUN. Kyunki nitrogenous jo waste hai, urea hai vo body se bahar nahi ja raha. Kidneys usko filter nahi kar rahi blood ko. To usse kya hoga blood mein serum creatinine and blood urea nitrogen ka deposition glomerulus mein dikhega. Elevated IgA levels, IgA levels bhi elevated hoga. IgA deposit ka matlab hai wahan par antigen antibody complexes ka deposition glomerulus mein dikhega. Estimated glomerular filtration rate.
[15:45]eGFR kya hota hai? Is mein hum GFR dekhte hai ki glomerular filtration rate kitna hai to ye humein reduced dekhne ko milega. Then ata hai treatment. Ab isko treat kaise karna hai? To kuch symptomatic management bhi hai, kuch causes ke base par bhi hai. Sabse pehle ata hai ACE inhibitors. Kyunki blood pressure high ho raha hai to usko reduce karne ke liye hum kya dete hai? ACE inhibitors dete hai. ACE inhibitors protein urea ko bhi minimize karte hai. To iske examples kya hai? Lisinopril and enalapril. Uske baad ata hai corticosteroids. Corticosteroids ye kya karte hai? Inflammation ko reduce karte hai. To ismein humein kya dete hai? Prednisolone dete hai jo ki inflammation ko kam karta hai. Lekin corticosteroids sath mein kya karta hai? Immune system ko bhi weak karta hai to humein patient ko education deni hai ki vo proper hygiene maintain kare. Iske alava corticosteroid hum isliye de rahe hai. Dekho yahan par ye immune system ko to weak kar raha hai lekin yahan par priority kya hai? Abhi inflammation ko control karna. Uske baad ata hai immunosuppressants agar koi autoimmune disease condition hai to uske liye agar jo corticosteroids hai vo itne effectively kaam nahi kar rahe to immunosuppressants bhi dene padte hai jo ki immunity ko suppress karte hai jaise ki cyclophosphamide and cyclosporine. Uske baad diuretics aate hai. Diuretics edema ko theek karte hai. Edema agar matlab fluid agar body se bahar chala gaya to blood pressure bhi kam hoga. Lekin diuretics tabhi dena hai agar renal status sahi hai. Agar renal status sahi nahi hai kidneys itna capable nahi hai un par jyada workload hum nahi dal sakte fir tab hum diuretics nahi dete. To ye depend karta hai person to person patient ki condition par. Uske baad ata hai lifestyle modification. To ismein lifestyle bhi change karna hota hai. Smoking, alcohol ye sab avoid karna hota hai. Regular exercise. Uske alava diet mein change karna hota hai. Kyunki fluid retain ho raha hai to low salt diet dete hai kyunki jitna salt ya sodium lenge utna jyada fluid retain hoga. Uske baad kya hota hai ki agar blood filter nahi ho raha properly to kya hota hai ki potassium ka level bhi blood mein high ho jata hai. To low potassium diet bhi ismein deni hai. Reduced protein intake. Vaise to kya hota hai ki kidneys protein ko bahar nikal rahi hai urine ke through to body mein protein ki kami ho rahi hai. Lekin sometimes humko protein intake ko kam karna padta hai. Kyun? Taki kidneys par jyada workload na pade agar kidneys itni capable nahi hai. To reduced protein intake kiya jata hai. Regular exercise hum patient ko advise karte hai. Uske alava hum patient ko kya bolte hai? Kyunki edema ho raha hai. To edema se skin kya ho jati hai? Bahut jyada fragile ho jati hai. Skin mein easily break down ho sakta hai. To humein frequently patient ko bolna hai apni position change kare. Agar patient capable nahi hai to nursing staff ko ya fir koi bhi healthcare staff kya karega? Uski regular patient ki position ko change karega. Iske alava aur education kya ho sakti hai? Intake output hum check kar sakte hai. Kitna intake le raha hai patient? Kitna output aa raha hai? Urine output kya aa raha hai? Daily weights kya hai? Daily weights hum koshish karenge ki same time par check kare. Uske baad agar kidneys chronic kidney disease usmein ho gay ya chronic glomerulonephritis ho gaya jis se kidneys bahut damage ho gayi hai ya fir renal failure ho gaya hai to option kya rehta hai? Dialysis ya fir kidneys transplant rehta hai. So I hope aapko acute glomerulonephritis clear hua. If you understood this video then please like, subscribe and share to my channel. Thank you for watching.
