Nephritic Syndrome
Nephritic Syndrome is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Description
- Acute glomerulonephritis (AGN) is acute inflammatory damage to glomerulus, associated with:
- Abrupt onset of hematuria with or without RBC casts
- Acute renal failure manifested by edema, hypertension, azotemia, decline in urine output
- Variable proteinuria
- Active urine sediment (RBC casts)
- Exact mechanism of AGN unclear:
- Combination of autoimmune reactivity to specific antigens at renal glomeruli
- Characterized by crescent formation secondary to nonspecific injury at the glomerular wall
Etiology
Etiology
- Poststreptococcal glomerulonephritis (PSGN):
- A postinfectious cause of acute nephritic syndrome, resulting from group A β-hemolytic streptococci
- Considered a nonsuppurative complication (antibiotic treatment does not prevent this complication)
- Occurs when immune complexes create hump-shaped subepithelial deposits in renal glomeruli
- Most commonly affects patients between ages 3 and 15 yr but can occur at any age
- Incidence of nephritis is 5–10% after pharyngitis and 25% after skin infections.
- Consider PSGN in the setting of new-onset proteinuria, RBC casts, edema, and any recent infection.
- Latent period between infection and onset of nephritis helps differentiate between PSGN and IgA nephropathy:
- 1–3 wk in pharyngeal infection
- 2–4 wk in cutaneous infection
- Renal biopsy is usually not necessary for diagnosis.
- Low complement (C3) for 6–8 wk
- Can progress to severe renal failure if underlying infection goes untreated
- Prognosis:
- Excellent; >95% recover spontaneously with normalization of renal function within 6–8 wk, even with dialysis.
- Hematuria usually resolves in 3–6 mo.
- Transient nephrotic phase in 20% of patients during resolution of illness
- End-stage renal disease occurs <5%
- Rapidly progressive glomerulonephritis (RPGN) is rare, occurring in <1% cases.
- Most cases resolve spontaneously with no long-term sequelae.
- Other infectious sources of glomerulonephritis (GN):
- Sepsis, pneumonia, endocarditis, viruses, HIV
- Pulmonary, intra-abdominal, or cutaneous infections
- Syphilis, leprosy, schistosomiasis, and malaria
- Goal: Treat underlying infection.
- Hepatitis virus–related glomerular disease:
- Can present with either nephritic or nephrotic symptoms
- Causes membranoproliferative GN
- Complements remain low indefinitely (compared to PSGN)
- Noninfectious causes of GN (due to immune complex formation):
- Systematic lupus erythematosus, Henoch–Schönlein purpura, vasculitis, Wegener granulomatosis
- Goodpasture syndrome
- IgA nephropathy (IgA-N)
- Most common cause of AGN (>25%) worldwide
- Antibody–antigen causes immune complex deposition of IgA and C3
- Complement levels are usually normal.
- IgA-N has different presentations:
- Gross hematuria following upper respiratory infection (URI)
- Microscopic hematuria with proteinuria
- Hematuria during viral illness or after exercise
- Prognosis is related to serum creatinine, BP, and proteinuria.
- 50% of patients with proteinuria may develop progressive renal disease.
- ACE inhibitors or angiotensin-receptor blockers (ARBs) may help
- RPGN:
- Certain patients with AGN may progress rapidly to renal failure.
- Hallmarks are crescents on renal biopsy.
- Hereditary nephritis
- Alport syndrome
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Citation
Rosen, Peter, et al., editors. "Nephritic Syndrome." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307492/all/Nephritic_Syndrome.
Nephritic Syndrome. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307492/all/Nephritic_Syndrome. Accessed December 5, 2019.
Nephritic Syndrome. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307492/all/Nephritic_Syndrome
Nephritic Syndrome [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 December 05]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307492/all/Nephritic_Syndrome.
* Article titles in AMA citation format should be in sentence-case
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