Acute Nephritic Syndrome

·         Acute illness characterized by:

o        Macroscopic or microscopic hematuria

o        Edema (mostly periorbital and also generalized)

o        Oliguria (urine volume <400mL/day)

o        HTN

o        Mild to moderate proteinuria (<3.5 g/day)

·         Common Causes

o        Primary GN

§         IgA nephropathy (Berger’s Disease)

§         Membranoproliferative GN

§         Crescentic GN (rapidly progressive glomeruloneprhitis; RPGN)

§         Fibrillary and immunotactoid glomerulonephritides (wow your friends with this awesome scrabble word – triple word score)

o        Secondary diseases

§         SLE is seen w/ both nephritic and nephrotic syndromes

§         Diabetic nephropathy

§         Post streptococcal GN

§         Monoclonal Ig deposition disease

§         Amyloidosis

§         HIV nephropathy

§         HBC and HCV associated diseases

§         Henoch Schonlein purpura

§         Hemolytic uremic syndrome

§         Thrombotic Thrombocytopenic purpura (TTP)

·         Diagnosis

o        History and Physical exam

o        Serum electrolytes

o        CBC

o        Urinalysis (to document hematuria)

o        Complement

o        ANCA (antineutrophil cytoplasmic antibody) – to diagnose vasculitis such as Wegner’s
 

o        Anti-GBM antibodies – to diagnose pulmonary renal syndrome

o        ASO titers – seen in post infection GN

o        CXR to see infiltrates

o        Renal biopsy (if indicated)

·         Complications

o        Volume dependent HTN due to retention of Na and H2O; treat w/ diuretics

o        CHF & Pulmonary Edema

o        Acute Renal Failure

o        Progression to CRF

Some Renal Diseases that present as acute GN

• an important feature used in differentiated b/t these syndromes is the latency period.
  • A patient presents in your office with complaints of red tinged urine. He tells you that he had a sore throat about 2 weeks ago. à post strep GN
  • A patient with IgA nephropathy will have had an URI that started 2 days before onset of hematuria
• Prognosis of IgA nephropathy depends upon Blood Pressure & Proteinuria
  • If the patient has hypertension, there will be a rapid progression to Chronic renal insufficiency.
  • For these patients, diuretics are not given to treat their HTN, instead ace inhibitors and ARBS are used.
• RPGN is diagnosed through a biopsy
  • Creatinine levels will increase daily until oliguria develops and eventually anuria
  • Treatment is w. steroids and chemotherapeutic agents such as cyclophosphamide.

Nephrotic Vs. Neprhitic

                                    Nephrotic                     Nephritic

Hematuria                     Trace                            Marked

Proteinuria                     Gross                            Mild®Moderate

Edema                          Gross                            Moderate

BP                                Normal or ¯                   ­ (volume dependent)

GFR                             Normal                          Decreased

Urine volume                  Normal or ¯                    Reduced

Serum albumin               ¯ ¯                              Normal or ­

Acute renal failure          Less frequent                Frequent

Thrombosis                   Common                       None (unless associated w/ Lupus)

Infection                        Frequent                        Less frequent

ESRD                           Slow progression       Rapid progression with certain exceptions

(end stage renal disease) 

• Acute renal failure is less frequent in nephrOtic syndrome unless a mistake is made by a doctor such as keeping the patient on too much diuretics or NSAIDs.
• Infection is frequent w/ nephrOtic syndrome due to edema & poor nutrition absorption. There are normal IgGs but they are not normally active compared to a normal healthy patient.

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