Nephritic syndrome is defined by hematuria, variable degrees of proteinuria, usually dysmorphic red blood cells (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) and occurs at any age. Causes differ by age (see table Glomerular Disorders by Age and Presentation), 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 IgA nephropathy Membranoproliferative GN
Secondary
Bacterial*	Group A beta-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 species)
Parasitic*	Malaria (due to Plasmodium falciparum or P. malariae) Schistosomiasis (due to Schistosoma mansoni)
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 [candidiasis] or Coccidioides immitis [cocciodiomycosis]) Rickettsial infection
Connective tissue disorders	Eosinophilic granulomatosis with polyangiitis Granulomatosis with polyangiitis IgA–associated vasculitis Microscopic polyangiitis Polyarteritis nodosa SLE
Drug-induced disorders	SLE (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 Thin basement membrane disease
* Infectious and postinfectious causes.
GN = glomerulonephritis; SLE = systemic lupus erythematosus.

Postinfectious glomerulonephritis is the prototype of acute glomerulonephritis, 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 glomerulonephritis resulting from the secondary sequelae of inflammatory (crescenteric) glomerulonephritis, of which there are many causes. RPGN is a pathologic diagnosis.

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

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Overview of Glomerular Disorders

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