Chronic nephritic syndrome

Nephritic syndrome
Classification and external resources
ICD-10 9 MedlinePlus 000495
Not to be confused with nephrotic syndrome.

Nephritic syndrome (or acute nephritic syndrome)[1] is a collection of signs (known as a syndrome) associated with disorders affecting the kidneys, more specifically glomerular disorders.[2] It is characterized by having a thin glomerular basement membrane and small pores in the podocytes of the glomerulus, large enough to permit proteins (proteinuria) and red blood cells (hematuria) to pass into the urine. By contrast, nephrotic syndrome is characterized by only proteins (proteinuria) moving into the urine. Both nephritic syndrome and nephrotic syndrome result in hypoalbuminemia due to protein albumin moving from the blood to the urine.

Hematuria can be caused by bleeding anywhere in the urinary tract, but if the RBCs are trapped in urinary casts, it is more likely that the bleeding originated in the nephron, and nephritic syndrome becomes more probable.

It is usually distinguished from nephrotic syndrome, but sometimes the two are described as associated in a minority of cases (occasionally — and confusingly— referred to as "nephritic/nephrotic," although this is considered a progression of a nephritic syndrome and categorically not a nephrotic syndrome).[3] Some conditions can cause either syndrome, and both syndromes can have a similar appearance upon biopsy. Neither term represents a definitive diagnosis, but both terms can be useful in the early stages of a differential diagnosis.

Signs and symptoms

Nephritic syndrome is characterized by;

and variable renal insufficiency, with;

The main features are hypertension and RBC casts. The proteinuria in nephritic syndrome is not usually severe, but may occasionally be heavy enough to be in the range usually found in nephrotic syndrome.

Mnemonic: PHAROAH = Proteinuria, Hematuria, Azotemia, RBC casts, Oliguria, Anti-strep titres (if post-strep), and Hypertension

Diagnosis

Nephritic syndrome is not a specific diagnosis. It is a clinical syndrome and characterized by the above signs.

An anti-streptolysin O titre (or ASOT) is typically done to test for exposure to streptococci. This test however has very poor specificity.

Differential diagnosis

The two classic diagnoses of nephritic syndrome are:

Nephritic syndrome causes are usually grouped into 'focal proliferative' and 'diffuse proliferative' on the basis of histology (obtained by a renal biopsy).

Focal proliferative

Diffuse proliferative

Treatment

Treatment is dependent on the underlying etiology (cause) and the degree of kidney dysfunction.

Prognosis

Because nephritic syndrome is not a disease, just a collection of symptoms, the prognosis depends on the underlying etiology.

References

External links

  • Acute nephritic syndrome - medlineplus.org
  • Nephritic syndrome - A to Z topics.
  • Nephritic syndrome - Merck Manual.
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