Nephritic Syndrome

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Acute Nephritic Syndrome

• Haematuria
• proteinuria
• hypertension
• fluid retention
• low urine output
• rising urea / creatinine

Causes

• diffuse proliferative glomerulonephritis
  • post-streptococcal infection
• mesangiocapillary
  • measles
• vasculitis

Clinical Features

• classically post-streptococcal infection
  • 1-3 weeks before
  • Lancefield group A / b-haemolytic

Investigations

• Urine microscopy
  • red cells / casts
• Urea & Creatinine raised
• culture
• Antistreptolysin O (ASO) titre
• C3 & C4 levels reduced
• ANA (in Systemic Lupus Erythematosus)
• ANCA (in vasculitis)
• Anti-GBM (Goodpastures syndrome)
• cryoglobulins
• creatinine clearance reduced
• urinary protein output increased
• CXR
  • cardiomegaly
  • pulmonary oedema
• Renal imaging (IVU / USS)
  • usually normal
• Renal biopsy
  • glomerulonephritis

Management

• corticosteroids / immunosupression of little benefit unless
  • Systemic Lupus Erythematosus
  • Wegener's Granulomatosis
  • Goodpasture's Syndrome
  • rapidly progressive cresentic glomerulonephritis
• Most managed at home
• In hospital management
  • daily fluid balance
  • daily weighing
  • regular measurement of blood pressure
  • ?protein restriction if uraemic
  • salt restriction
  • fluid restriction
  • antihypertensives
  • antibiotics if streptococcal infection

Acute Nephritic Syndrome

• haematuria
• proteinuria
• hypertension
• oedema
• oliguria
• uraemia

Investigations

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