Nephritic Syndrome, Clinical Presentation, Diagnosis and Treatment

Nephritic Syndrome

Acute nephritic syndrome indicates an inflammatory process causing renal dysfunction over days to weeks that may or may not resolve. In severe cases it may cause more than 50% loss of nephron function over the course of just weeks or months. It affect the process of glomerular filtration and renal tubular reabsorption.

It is characterized by the abrupt onset of:

• Hematuria with RBC casts or dysmorphic RBCs typically seen on urine microscopy.
• Proteinuria (usually non-nephrotic range).
• Renal impairment: manifesting as oliguria, uremia, raised urea and creatinine.
• Hypertension due to salt and water retention.
• Edema (usually periorbital, leg or sacral) due to salt and water retention.

ACUTE NEPHRITIC SYNDROME Clinical Presentation

• Hematuria ( micro or macroscopic)
• Proteinuria
• Hypertension
• Edema
• Oliguria ,
• Uremia

 

Glomerual diseases with nephritic presentation

Diseases of glomerulus may present clinically as nephritic syndrome. Flowing glomerual diseases usually present as nephritic syndrome.

• "Post-streptococcal glomerulonephritis" (most common), usually follows untreated strep throat in children
• IgA nephropathy
• Henoch - schonlein purpura
• Wagener’s granulomatosis
• Goodpasteur’s syndrome
• Polyarteritis nodosa
• Acute interstitial nephritis
• Essential mixed cryoglobinemia

 

Investigations to Diagnose the Nephritic Syndrome

Serum chemistries

• Complement levels
• ANA, ANCA, anti- GBM antibodies, cryoglobulins
• Hepatitis C and B
• ASO titer
• C3 nephritic factor

 

Urinalysis

• Dysmorphic red cells
• Red cell cast
• Proteinuria

 

Renal biopsy

If there is no contraindication

 

Treatment of Nephritic Syndrome

• Reduction of hypertension
• salt - water restriction
• Diuretics
• Corticosteroids and cytotoxic drugs (according to the histological pattern—not effective for all cases).