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Overview of Nephritic Syndrome

By

Frank O'Brien

, MD, Washington University in St. Louis

Last full review/revision Jan 2020| Content last modified Jan 2020
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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

Table
icon

Causes of Glomerulonephritis

Type

Examples

Primary

Idiopathic

Idiopathic crescentic GN

Secondary

Bacterial*

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*

Other infectious and postinfectious causes

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

Connective tissue disorders

SLE

Drug-induced disorders

SLE (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; SLE = systemic lupus erythematosus.

Acute glomerulonephritis

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

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

Drugs Mentioned In This Article

Drug Name Select Trade
No US brand name
GEMZAR
MITOSOL
PLATINOL
QUALAQUIN
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