Nephritic Syndrome, Clinical Presentation, Diagnosis and Treatmentrenal 2/11/2013
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)
- Oliguria ,
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
- Complement levels
- ANA, ANCA, anti- GBM antibodies, cryoglobulins
- Hepatitis C and B
- ASO titer
- C3 nephritic factor
- Dysmorphic red cells
- Red cell cast
If there is no contraindication
Treatment of Nephritic Syndrome
- Reduction of hypertension
- salt - water restriction
- Corticosteroids and cytotoxic drugs (according to the histological pattern—not effective for all cases).