Acute nephritic syndrome

• IgA nephropathy
• Henoch-Schonlein purpura
• hemolytic uremic syndrome
• post-streptococcal glomerulonephritis
• glue sniffing; gasoline inhalation
• bacterial infection or sepsis

Associated diseases generally seen more frequently in adults:

• SLE ; lupus nephritis
• membranoproliferative GN I
• membranoproliferative GN II
• infective endocarditis
• vasculitis
• rapidly progressive (crescentic) glomerulonephritis
• Goodpasture's syndrome
• Klebsiella pneumonia
• abdominal abscesses
• viral diseases: mononucleosis , measles , mumps , and so on
• typhoid fever
• hepatitis
• syphilis and other sexually transmitted diseases

Inflammation disrupts the functioning of the glomerulus, which is the part of the kidney that controls filtering and excretion. Inefficient glomerular functioning results in the loss of blood and protein in the urine and the accumulation of excess fluid in the body. Swelling results when protein is lost from the blood stream. (Protein maintains fluid within the blood vessels, and when it is lost the fluid collects in the tissues of the body).

Urine discoloration results from blood in the urine . This occurs because of loss of blood within the damaged glomeruli.

Acute nephritic syndrome may be associated with the development of hypertension, interstitial inflammation (inflammation of the spaces between the cells of the kidney tissue), and acute renal failure .

The disorder is uncommon, affecting 4 out of 100,000 persons. It affects both sexes and is evenly distributed across age groups.

Prevention:
Many times the disorder cannot be prevented, although treatment of illness and infection may help to reduce the risk.

Symptoms:

• blood in the urine
• urine that appears dark, cola or tea colored , or cloudy
• decreased urine volume (Little or no urine may be produced.)
• swelling
  • facial swelling
  • swelling around the eye socket (periorbital)
  • arms, hands, feet, legs ( dependent edema )
  • abdomen
  • generalized ( anasarca )

• general aches and pains (See joint pain , muscle aches .)
• general ill feeling ( malaise )
• headache
• blurred vision
• slow, sluggish, lethargic movement

Late symptoms:

• seizures
• decreased alertness , drowsiness , confusion
• nausea , vomiting
• easy bruising or bleeding
• cough containing mucus (mucoid sputum) or pink, frothy material coughed up
• difficulty breathing
  • worse at night
  • that occurs while lying down
  • aggravated by exercise

• flank pain
• blood pressure, high

Signs and Tests:
Blood pressure may be elevated. There may be signs of fluid overload (more fluid in the circulation than the heart can effectively pump), including abnormal heart and lung sounds. The jugular (neck) veins may be distended from increased venous pressure. Generalized edema is often present. Examination of the abdomen with the hands ( palpation ) may indicate fluid overload and enlarged liver . There may be signs of acute renal failure in addition to the above symptoms.

• Urinalysis may show protein , renal tubular cells, blood, white blood cells, and casts .
• Protein, urine test may be positive.
• Urine appearance and color are abnormal
• Azotemia (collection of nitrogen-containing waste products in the blood) may be evidenced by:
  • elevated BUN
  • elevated creatinine

• The creatinine clearance may be decreased.
• A potassium test may be elevated.
• A kidney biopsy reveals glomerulonephritis (inflammation of the glomeruli) and may indicate the cause.

Tests for the cause of the acute nephritic syndrome may include:

• culture of the throat or skin
• blood culture
• ANA titer ( lupus )
• serum complement ( C3 and C4 )
• ANCA (antinutrophil cytoplasmic antibody for vasculitis)
• anti-glomerular basement membrane antibody

Treatment:
The goal of treatment is to reduce glomerular inflammation. Hospitalization is required for diagnosis and treatment of many forms of acute nephritic syndrome. The cause must be identified and treated. This may include antibiotics or other medications or treatment.

Bedrest may be recommended. The diet may include restriction of salt, and/or fluids, and/or potassium. Medications may include anti-hypertensive medications to control high blood pressure . Corticosteroids or other anti-inflammatory medications may be used to reduce inflammation.

Other treatment of acute renal failure may be appropriate.

Support groups
The stress of illness can often be helped by joining a support group where members share common experiences and problems. See kidney disease - support group .

Prognosis:
The probable outcome is variable and depends on the disease responsible for the nephritis. When improvement occurs, symptoms associated with fluid retention (such as swelling and cough ) and hypertension may resolve in a week or two, while urine tests take months to return to normal.

Children tend to do better than adults and usually recover completely. Only rarely do they develop complications or progress to chronic glomerulonephritis .

Adults do not recover quite as well or as rapidly as children. Although recurrence is unusual, at least one-third of adults whose acute nephritic syndrome recurs will eventually develop end-stage renal disease .

Complications:

• acute renal failure
• chronic glomerulonephritis
• chronic renal failure
• end-stage renal disease
• hypertension
• congestive heart failure
• pulmonary edema
• nephrotic syndrome

Call Your Healthcare Provider:
Call your health care provider if symptoms that are suggestive of acute nephritic syndrome develop.


The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production. The gross anatomical structure of the kidney is illustrated.