Renal System >
Nephritic Syndrome

A syndrome consisting of symptoms related to inflammation of the glomeruli

Risk Factors
  • Modifiable: n/a
  • Non-Modifiable:
    • Recent Infections
    • Underlying immune system disorders (such as Systemic Lupus Erythematosus or Vasculitis)
    • Certain genetic disorders
    • Family history of Kidney disease
Aetiology
  • IgA nephropathy (Berger’s disease) – The commonest cause of primary GN and is commonly seen in children 1-2 days post-URTI
  • Post-streptococcal GN – seen in children/adolescences but is usually 2-3 weeks post-streptococcal infection (tonsillitis, impetigo)
  • Membranoproliferative GN (primary or SLE) – seen in adults
  • Goodpasture’s syndrome (autoantibodies against BM) – also affects lungs = haemoptysis due to type IV collagen involvement)
Pathophysiology
  • Inflammatory process affecting the glomeruli → increased capillary permeability → RBC’s leaking into the tubule and therefore appear in urine → reduced GFR → AKI
  • The exact cause of inflammation is dependent on the underlying cause and can be either infective or auto-immune with immune complex deposition. 
Clinical Presentation
  • Abrupt onset of haematuria (cola-coloured urine) with RBC casts in the urine
  • Sterile pyuria (cloudy with pus)
  • Hypertension
  • Oliguria (AKI)
  • There may also be mild proteinuria (<3.5g/day) but less than nephrotic syndrome
  • If left untreated they may present with uraemic symptoms form AKI.
Investigations
  • Bloods:
    • Urea and Electrolytes – assess Glomerular Filtration Rate for AKI
  • Imaging: n/a
  • Special:
    • Urinalysis – Any haematuria?
    • Renal biopsy – diagnose the underlying cause
Management
  • Conservative: n/a
  • Medical:
    • Control blood pressure – ACE Inhibitors or angiotensin receptor blockers
    • Reduce inflammation – use steroids
  • Surgical: n/a
Complications
  • Quickly progress into AKI and have the complications associated with this
  • Chronic inflammation can result in CKD and may result in the need for dialysis/renal transplantation
  • Prognosis is usually better in children than it is in adults.

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