2- nephritic syndrome

• Nephritic syndrome


  Association of hematuria with RBC casts, sub-nephrotic range proteinuria, edema, hypertension, oliguria, azotemia, and renal impairment/failure
• Nephritic syndrome


  • Due to glomerular injury with glomerular inflammation secondary to an immunological event
  • Immune-complex deposition activates complement à C5a attracts neutrophils à damage to basement membrane, mesangium, or endothelium
• Presentations of nephritic syndrome


  • Acute nephritic syndrome (acute glomerulonephritis)
  • Rapidly progressive glomerulonephritis
  • Chronic glomerulonephritis/chronic renal failure
• Causes of nephritic syndrome

  • Post-streptococcal glomerulonephritis
  • SLE
  • Membranoproliferative glomerulonephritis
  • Cryoglobulinemia
  • Anti-GBM (Goodpasture syndrome)
  • IgA nephropathy (HSP)
  • Vasculitis
• Post-streptococcal glomerulonephritis


  • A diffuse proliferative type of glomerulonephritis
  • Most common cause of acute nephritis worldwide
  • Group A strept (strept. Pyogens)
  • Occurs 1–12 weeks after a sore throat or skin infection (streptococcal antigen deposited on the glomerulus à host reaction and immune complex formation)
• Presentation of post-streptococcal glomerulonephritis


  • Microscopic hematuria
  • Acute nephritic syndrome (gross hematuria, proteinuria, edema, hypertension, and acute kidney injury)
• Diagnosis of post-streptococcal glomerulonephritis


  Findings of acute nephritis + demonstration of a recent GAS infection (positive throat or skin culture or serologic tests [anti-streptolysin titer ASOT), low complement, RBC casts
• Renal biopsy findings in post-streptococcal glomerulonephritis
• Management of post-streptococcal glomerulonephritis


  • Supportive, >95% recover normal renal function
  • Antibiotic therapy is given to those who have still have a streptococcal infection at the time of diagnosis
• Anti-GBM (Goodpasture syndrome)


  • Caused by autoantibodies to type IV collagen, which is highly expressed in the GBM and alveoli
  • Usually presents with rapidly progressive glomerulonephritis: acute renal failure (may occur within days), nephritic urine sediment, and non-nephrotic proteinuria
  • Pulmonary involvement (alveolar hemorrhage à hemoptysis & dyspnea) is present in 40 to 60% of patients, especially in smokers
• Diagnosis of Anti-GBM (Goodpasture syndrome)

  Demonstration of anti-GBM antibodies, so kidney biopsy is required: Linear deposits of IgG along the GBM is diagnostic
• Treatment of Anti-GBM (Goodpasture syndrome)

  • Plasma exchange to remove the autoantibodies, steroids ± cyclophosphamide
  • If treatment is started early, full recovery is possible, and relapses are rare
  • Renal prognosis is poor if dialysis-dependent at presentation
• IgA nephropathy (HSP)


  • Most common cause of chronic glomerulonephritis in developed countries
  • Common cause of mild recurrent hematuria
  • Most patients present with either gross hematuria (single or recurrent), usually accompanying an upper respiratory infection or after exercise, or microscopic hematuria with or without mild proteinuria incidentally detected on a routine examination
  • Occasionally they might present with rapidly progress glomerulonephritis & nephritic syndrome
  • lgA production is increased during infections à forms immune complexes and deposits in mesangial cells
  • When accompanied by extra-renal symptoms: purpuric skin lesions, abdominal pain, arthralgia à Henoch-Schoenlein purpura
• Renal biopsy findings in IgA nephropathy
• Treatment of IgA nephropathy

  • Supportive
  • ACEI should be given to all patients
  • Steroids/immunosuppression may slow decline of renal function if persistent proteinuria
• Prognosis of IgA nephropathy
• Investigations for nephritic syndrome

  • Urine microscopy for red cells and casts
  • RFT (Serum urea and creatinine raised)
  • Creatinine clearance (low)
  • 24-hour urine protein (raised)
  • C3 and C4 (low), Normal complement in IgA nephropathy & anti-GBM
  • Chest X-ray for pulmonary edema
  • Renal imaging (normal size)
  • Renal biopsy if needed
  • Diagnostic tests for specific causes: Throat swab, Antistreptolysin O titer, ANCA, Anti-GBM antibody, Cryoglobulins
• General management of nephritic syndrome


  • Daily weight checks
  • Fluid balance chart
  • Antihypertensive & BP monitoring
  • Salt restriction
  • Fluid restriction
  • Diuretics
  • Dialysis if needed
  • Specific treatment for each cause if needed
• Alport syndrome


  • Congenital defect of collagen IV à glomerular disease
  • Sensorineural hearing loss, visual disturbances (lens lenticonus)
  • Hematuria and hypertension
  • Always in males X-linked dominant
  • Histology: basket weave shaped
• Thin membrane disease


  • Only hematuria
  • Very benign