Nephritic syndrome causes, clinical picture, investigations, treatment, prognosis

This is a discussion of nephritic syndrome regarding its definition, causes, clinical picture (manifestations), diagnostic investigations and treatment approach .

Definition of Nephritic syndrome

• It is a clinical syndrome characterized by sudden onset (days) of haematuria, proteinuria, oligurea & hypertension and azotemia with RBCs casts, dysmorphic RBCs in urine, the proteinuria is a non nephrotic range proteinuria.

Causes of nephritic syndrome

1. Post infectious
       - Usually, it develops 7-20 days after streptococcal infection with
       group A beta hemolytic streptococcus of a nephritogenic type ( 1,
       2, 4, 12,18, 25, 49, 55, 57, 60).
      - Staphylococci- pneumococci - viral.
2. SLE.
3. Vasculitis.
4. Henoch-Schonlein purpura.
5. Infective endocarditis.
 6. Shunt nephritis.
 7. Cryoglobulinemia.

Clinical picture of Nephritic syndrome

1. Oligurea as cell proliferation of glomeruli  decreaes GFR.
2. Hypertension
    - Hypertensive encephalopathy.
    - Hypertensive heart failure.
3. Edema :  mainly due to salt & H2O retention.

Investigatigns to diagnose Nephritic syndrome

1. Urea ++, Creatinine ++ , RBCs and RBCs casts in urine.
2. Proteins < 3 gm/day, sometimes> 3 gm/day.
3. Markers for SLE, ASOT, ANCA.
4. C3, C4 levels may be reduced.
5. Cryoglobulins are increased in cryoglobulinemia.
6. Renal image is usually normal.
7. Biopsy, specially if there is rapidly progressive renal failure suggesting cresentic G.N (RPGN).

Treatment of Nephritic syndrome

1. Fluid chart :
       - Control blood pressure
       - Salt restriction
       - Protein restriction is required only if severe uremia occurs.
       - Regular measurement of blood pressure and daily weighing.

2. Mild to moderate hypertension and edema may respond to salt restriction and diuretics e.g. frusemide, but other hypotensive agents may be required.

3. Treatment of the cause e.g. antibiotics for post infectious G.N and steroids in SLE.

4. Treatment of complications:
- Hypertensive encephalopathy is treated by parenteral agents e.g hydralazine, nitrates or Na nitroprusside by slow I.V infusion.
* Fits can be controlled with LV diazepam.
- Pulmonary edema is treated as usual .
 High doses of frusemide may be required. If this fails to produce diuresis, fluids can be removed by ultrafiltration using the hemodialysis machine.

Prognosis of Nephritic syndrome

1. Poststreptococcet G.N: The prognosis in children is excellent. A small number of adults develop hypertension and / or renal impairment later in life.
2. Acute G.N of unknown cause: The prognosis is less good.
3. Systemic vasculitides and crescentic G.N: are usually of poor prognosis is poor.

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