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Nephritic syndrome

by | 15 Apr, 2021

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Introduction

Nephritic syndrome is a collection of symptoms and signs associated with inflammatory glomerular disorders. An inflammatory response within the glomeruli results in glomerular basement membrane disruption. This leads to renal excretion of red blood cells and reduced glomerular filtration rate (GFR), which produces haematuria and raised renin (increasing blood pressure and producing oedema).

It is important to note that the term nephritic syndrome refers to a presentation of disease rather than being a disease itself. It is generally associated with the development of glomerulonephritis.

Glomerular diseases can present with features of both nephrotic and nephritic syndrome; both syndromes are considered as part of a spectrum, with some diseases being more likely to present with features of one of the syndromes.

Causes

Primary renal disease

Primary renal conditions presenting primarily with nephritic syndrome features include:

  • Alport syndrome

Conditions presenting with mixed nephrotic and nephritic syndrome features include:

  • IgA nephropathy
  • Membranoproliferative glomerulonephritis

Secondary renal disease

Secondary diseases that can present with nephritic syndrome include:

  • Post-streptococcal glomerulonephritis
  • Henoch-Schonlein purpura
  • Goodpasture’s syndrome
  • Vasculitis e.g. ANCA-positive vasculitis
  • Proliferative glomerulonephritis e.g. in systemic lupus erythematosus
  • Rapidly progressive glomerulonephritis

Clinical features

Compared to nephrotic syndrome, nephritic syndrome is characterised by hypertension and haematuria. It is more commonly associated with the development of kidney dysfunction.

Clinical features include:

  • Haematuria
  • Hypertension
  • Proteinuria (usually < 3.5 g/day)
  • RBC casts in urine
  • Mild to moderate oedema
  • Oliguria
  • Sterile pyuria

Investigations

Investigations are aimed at diagnosing the underlying cause and are the same tests performed when investigating glomerulonephritis, which are as follows.

Urine tests

  • Urine dipstick
  • Urine microscopy and culture
  • Urine albumin:creatinine ratio

Blood tests

  • Urea and electrolytes
  • Full blood count
  • C-reactive protein
  • ESR
  • HbA1C
  • Immunology:
  • Complement levels
  • ANCA
  • ANA
  • Anti-dsDNA
  • Anti-GBM
  • Antistreptolysin O titre

Imaging

  • Renal ultrasound
  • Chest x-ray

Invasive tests

Renal biopsy

Management

Treatment should be directed at the underlying cause of nephritic syndrome.

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