Nephritic Syndrome

Question 1

What is nephritic syndrome?

Answer 1

Characterised by glomerular capillary damage leading to Hematuria, pyuria, water retention and subsequent hypertension and oedema

Question 2

What are some of the causes of nephritic syndrome?

Answer 2

Poststreptococcal glomerulonephritis
IgA nephropathy (Berger disease)
Granulomatosis with polyangiitis
Microscopic polyangiitis
Eosinophilic granulomatosis with polyangiitis
Goodpasture syndrome (anti-GBM disease)
Alport syndrome (hereditary nephritis)
Thin basement membrane disease
Rapidly progressive glomerulonephritis (RPGN)
Lupus nephritis
Most common causes of nephritic-nephrotic syndrome:
Membranoproliferative glomerulonephritis
Diffuse proliferative glomerulonephritis

Question 3

What is the clinical definition of nephritic syndrome?

Answer 3

Hematuria with acanthocytes
RBC casts in urine
Proteinuria (< 3.5 g/24 h)
Hypertension
Mild to moderate edema
Sterile pyuria
Oliguria
Azotemia

Question 4

What is the summary pathophysiology of nephritic syndrome?

Answer 4

Inflammation -> cytokine release -> glomerular capillary damage

Question 5

What are the clinical features of nephritic syndrome?

Answer 5

Intermittent gross Hematuria (red or brown urine)
Hypertension
Pitting oedema
If decreased GFR - Oliguria and uraemia symptoms eg fatigue, weakness and headaches

Question 6

What is the diagnosis for nephritic syndrome?

Answer 6

Urinalysis - nephritic sediment - Hematuria, acanthocytes, red blood cell casts, mild to moderate proteinuria of >150mg/24 hours, but less than 3.5g/24 hours, sterile pyuria

Blood tests - increased creatinine, decreased GFR, azotemia with increased BUN, complement, ANA, ANCA and anti-GBM antibodies

Renal biopsy - sometimes indicated in patients with a non specific disease pattern to confirm diagnosis

Question 7

What is the treatment for nephritic syndrome?

Answer 7

Supportive therapy
Low-sodium diet
Water restriction

Medical therapy
If proteinuria and/or hypertension: angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers
If severe hypertension and/or edema: diuretics
Sometimes immunosuppressive therapy is indicated (e.g., in lupus nephritis).
If RPGN from anti-GBM antibody disease: plasmapheresis

In the case of:
Severe renal insufficiency or kidney failure: renal replacement therapy (e.g., hemodialysis, possibly transplantation)
Membranoproliferative glomerulonephritis (type 1 and type 2 MPGN)
RAAS inhibitors are often added to treatment
Prednisone alone or in combination with other immunosuppressants (cyclosporine OR tacrolimus)