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Overview of Nephritic Syndrome

By Navin Jaipaul, MD, MHS, Associate Professor of Medicine; Chief, Nephrology, Loma Linda University School of Medicine; VA Loma Linda Healthcare System

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Nephritic syndrome is defined by hematuria, variable degrees of proteinuria, usually dysmorphic RBCs, and often RBC casts on microscopic examination of urinary sediment. Often 1 of the following elements are present: edema, hypertension, elevated serum creatinine, and oliguria. It has both primary and secondary causes. Diagnosis is based on history, physical examination, and sometimes renal biopsy. Treatment and prognosis vary by cause.

Nephritic syndrome is a manifestation of glomerular inflammation (glomerulonephritis [GN]) and occurs at any age. Causes differ by age (see Table: Glomerular Disorders by Age and Manifestations), and mechanisms differ by cause. The syndrome can be

  • Acute (serum creatinine rises over many weeks or less)

  • Chronic (renal insufficiency may progress over years)

Nephritic syndrome can also be

  • Primary (idiopathic)

  • Secondary

Causes of Glomerulonephritis

Type

Examples

Primary

Idiopathic

Fibrillary and immunotactoid GN

Idiopathic crescentic GN

Secondary

Bacterial*

Mycoplasmainfection

Neisseria meningitidisinfection

Salmonella typhiinfection

Staphylococcal infections (especially bacterial endocarditis)

Streptococcus pneumoniaeinfection

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

Parasitic*

Malaria (due to Plasmodium falciparum or P. malariae)

Schistosomiasis (due to Schistosoma mansoni)

Viral*

Other infectious and postinfectious causes

Fungal infections (due to Candida albicans [candidiasis] or Coccidioides immitis [cocciodiomycosis])

Connective tissue disorders

SLE

Drug-induced disorders

SLE (rarely due to hydralazine or procainamide)

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

Hematologic dyscrasias

Serum sickness

Glomerular basement membrane diseases

Hereditary disorders

*Infectious and postinfectious causes.

GN = glomerulonephritis.

Acute glomerulonephritis

Postinfectious GN is the prototype of acute GN, but the condition may be caused by other glomerulopathies and by systemic disorders such as connective tissue disorders and hematologic dyscrasias (see Table: Causes of Glomerulonephritis).

Rapidly progressive glomerulonephritis (RPGN) is an acute GN resulting from the secondary sequelae of inflammatory (crescenteric) glomerulonephritis, of which there are many causes. PPGN is a pathologic diagnosis.

Chronic glomerulonephritis

Chronic GN has features similar to those of acute GN but develops slowly and may cause mild to moderate proteinuria. Examples include

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