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Nephritic Syndrome

Study guide:

 

Definition:

  • Nephritic syndrome is a manifestation of glomerular inflammation (glomerulonephritis [GN]) due to many causes leading to leakage of the larger cells (red blood cells – plasma proteins) through the filtration barrier.

  • The classic features are: hematuria, edema and hypertension.


Clinical and laboratory findings:

  • Clinical

    • HTN, edema.

  • Laboratory

    • Hematuria (macro & micro), non-nephrotic range proteinuria, azotemia due to decrease in the glomerular filtration rate (GFR) and renal failure. 

Causes:​

Type

Examples

Secondary: 

Bacterial*

  • Group A β-streptococcal infection

  • Mycoplasma infection

  • Neisseria meningitidis infection

  • Salmonella typhi infection

  • Staphylococcal infections (especially bacterial endocarditis)

  • Streptococcus pneumoniae infection

  • Visceral abscesses (due to Escherichia coli or Pseudomonas, Proteus, Klebsiella, or Clostridium sp)

  • Sepsis

Secondary:

Parasitic*

  • Malaria (due to Plasmodium falciparum or P. malariae)

  • Schistosomiasis (due to Schistosoma haematobium or S. mansoni)

  • Toxoplasmosis

Secondary:

Viral*

  • Coxsackievirus infection

  • Cytomegalovirus infection

  • Epstein-Barr virus infection

  • Hepatitis B

  • Hepatitis C

  • Herpes zoster

  • Measles

  • Mumps

  • Varicella

Secondary:

Other infectious and postinfectious causes

  • Fungal infections (due to Candida albicans or Coccidioides immitis)

  • Rickettsial infection

Secondary:

Connective tissue disorders

Secondary:

Drug-induced disorders

  • SLE (rarely due to hydralazine or procainamide)

  • Hemolytic-uremic syndrome (due to quinine, cisplatin, gemcitabine, or mitomycin C)

Secondary:

Hematologic dyscrasias

Secondary:

Glomerular basement membrane diseases

  • Goodpasture syndrome

Secondary:

Hereditary disorders

  • Hereditary nephritis (Alport syndrome)

  • Thin basement membrane disease

Primary:

Idiopathic

  • Fibrillary GN

  • Idiopathic crescentic GN

  • IgA nephropathy

  • Membranoproliferative GN

  • Immunotactoid GN

  • Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

  • Granulomatosis with polyangiitis (formerly Wegener granulomatosis)

  • Immunoglobulin A–associated vasculitis (Henoch-Schönlein purpura)

  • Microscopic polyangiitis

  • Polyarteritis nodosa

  • SLE

  • Mixed IgG-IgM cryoglobulinemia

  • Serum sickness

  • Thrombotic thrombocytopenic purpura–hemolytic-uremic syndrome

*Infectious and postinfectious causes Adopted from Crash Course Nephrology 4th edition & Kumar &Clark’s Clinical Medicine 8th edition. Edited by LtMed

Diagnosis:

  • Renal biopsy is the gold method.

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Management: 

  • Treatment vary by cause.

  • Treatment options include ACEinhibitors, angiotensin II receptor blockers, corticosteroids and immunosuppressant. 

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References:

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Written by:         Sarah Qubaiban

Reviewed by:     Al Waleed Al Yamani

                          Lama Al Luhidan

Format editor:   Roaa Amer                                         

Publisher:          Bader Altamimi

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