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Overview of Nephritic Syndrome

by Navin Jaipaul, MD, MHS

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 Glomerular Disorders by Age and Manifestations), and mechanisms differ by cause. The syndrome can be acute or chronic and primary (idiopathic) or secondary.

Postinfectious GN is the prototype of acute GN (see Postinfectious Glomerulonephritis), but the condition may be caused by other glomerulopathies and by systemic disorders such as connective tissue disorders and hematologic dyscrasias (see Causes of Glomerulonephritis). Rapidly progressive glomerulonephritis (see Rapidly Progressive Glomerulonephritis (RPGN)) is another acute GN. Chronic GN has features similar to those of acute GN but develops slowly and may cause mild to moderate proteinuria. Examples include IgA nephropathy (see Immunoglobulin A Nephropathy (IgA Nephropathy)), hereditary nephritis (see Hereditary Nephritis), and thin basement membrane disease (see Thin Basement Membrane Disease).

Causes of Glomerulonephritis

Type

Examples

Primary

Idiopathic

Fibrillary GN

Idiopathic crescentic GN

IgA nephropathy

Membranoproliferative GN

Immunotactoid GN

Secondary

Bacterial*

Group A β-streptococcal infection

Mycoplasma infection

Neisseria meningitidis infection

Salmonella typhi infection

Staphylococcal infections (especially bacterial endocarditis)

Streptococcus pneumoniae infection

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

Sepsis

Parasitic*

Malaria (due to Plasmodium falciparum or P. malariae)

Schistosomiasis (due to Schistosoma haematobium or S. mansoni)

Toxoplasmosis

Viral*

Coxsackievirus infection

Cytomegalovirus infection

Epstein-Barr virus infection

Hepatitis B

Hepatitis C

Herpes zoster

Measles

Mumps

Varicella

Other infectious and postinfectious causes

Fungal infections (due to Candida albicans or Coccidioides immitis)

Rickettsial infection

Connective tissue disorders

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

Granulomatosis with polyangiitis (formerly Wegener granulomatosis)

Immunoglobulin A–associated vasculitis (Henoch-Schönlein purpura)

Microscopic polyangiitis

Polyarteritis nodosa

SLE

Drug-induced disorders

SLE (rarely due to hydralazine or procainamide)

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

Hematologic dyscrasias

Mixed IgG-IgM cryoglobulinemia

Serum sickness

Thrombotic thrombocytopenic purpura–hemolytic-uremic syndrome

Glomerular basement membrane diseases

Goodpasture syndrome

Hereditary disorders

Hereditary nephritis (Alport syndrome)

Thin basement membrane disease

*Infectious and postinfectious causes.

GN = glomerulonephritis.

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  • GEMZAR
  • PLATINOL
  • MITOSOL
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  • QUALAQUIN

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