Acute nephritic syndrome

Answer 1

Definition

Acute nephritic syndrome is a group of disorders that cause swelling or inflammation of the internal kidney structures (specifically, the glomeruli).

Nephritic syndrome is a type of glomerulonephritis.

Alternative Names

Glomerulonephritis - acute; Acute glomerulonephritis; Nephritis syndrome - acute

Causes, incidence, and risk factors

Acute nephritic syndrome is often caused by an immune response that is triggered by an infection or other disease.

Frequent causes in children and adolescents include the following:

• IgA nephropathy
• Henoch-Schonlein purpura
• Hemolytic uremic syndrome
• Post-streptococcal glomerulonephritis

Frequent causes in adults include:

• Abdominal abscesses
• Infective endocarditis
• Klebsiella pneumonia
• Goodpasture syndrome
• Hepatitis
• Membranoproliferative GN I
• Membranoproliferative GN II
• Rapidly progressive (crescentic) glomerulonephritis
• SLE or lupus nephritis
• Syphilis and other sexually transmitted diseases
• Typhoid fever
• Vasculitis
• Viral diseases such as mononucleosis, measles, mumps

The inflammation disrupts the functioning of the glomerulus, which is the part of the kidney that controls filtering and getting rid of wastes. This disruption results in blood and protein appearing in the urine, and the buildup of excess fluid in the body.

Swelling occurs when protein is lost from the bloodstream. (Protein maintains fluid within the blood vessels, and when it is lost the fluid collects in the tissues of the body). Blood loss from the damaged kidney structures leads to blood in the urine.

Acute nephritic syndrome may be associated with the development of:

• High blood pressure
• Swelling of the spaces between the cells of the kidney tissue
• Acute kidney failure

Symptoms

Common symptoms of nephritic syndrome are:

• Swelling of the face, eye socket, legs, arms, hands, feet, abdomen, or other areas
• Blood in the urine (urine appears dark, tea colored, or cloudy)
• Decreased urine volume (little or no urine may be produced)

Other symptoms that may occur include:

• Blurred vision
• General aches and pains (joint pain, muscle aches)
• General ill feeling (malaise)
• Headache
• Slow, sluggish, lethargic movement
• Coughcontaining mucus or pink, frothy material
• Decreased alertness, drowsiness, confusion

Patients may develop symptoms of acute kidney failure or end-stage kidney disease.

Signs and tests

During an examination, your health care provider may find the following signs:

• High blood pressure
• Signs of fluid overload (when examining the abdomen)
• Enlarged liver
• Abnormal heart and lung sounds
• Enlarged neck veins from increased pressure
• General swelling
• Signs of acute kidney failure

Tests that may be done include:

• BUN
• Creatinine
• Creatinine clearance
• Urinalysis
• Urine appearance and color
• Potassium test
• Protein in the urine

A kidney biopsywill reveal inflammation of the glomeruli, which may indicate the cause.

Tests to determine the cause of acute nephritic syndrome may include:

• ANA titer (lupus)
• ANCA (antineutrophil cytoplasmic antibody for vasculitis)
• Anti-glomerular basement membrane antibody
• Blood culture
• Culture of the throat or skin
• Serum complement (C3 and C4)

Treatment

The goal of treatment is to reduce the inflammation. You may need to stay in a hospital to have acute nephritic syndrome diagnosed and treated. The cause must be identified and treated. Treatment may include antibiotics or other medications or therapies.

Your doctor may recommend bedrest. You may need to limit salt, fluids, and potassium in your diet. Your health care provider may prescribe medications to control high blood pressure. Corticosteroids or other anti-inflammatory medications may be used to reduce inflammation.

Other treatment of acute kidney failure may be appropriate.

Support Groups

For information and support, see kidney disease support groups.

Expectations (prognosis)

The outlook depends on the disease causing the nephritis. When the condition improves, symptoms of fluid retention (such as swelling and cough) and high blood pressure may go away in 1 or 2 weeks. However, urine tests take months to return to normal.

Children tend to do better than adults and usually recover completely. Only rarely do they develop complications or progress to chronic glomerulonephritis.

Adults do not recover as well or as quickly as children. Although it is unusual for the disease to return, at least one-third of adults whose acute nephritic syndrome does return will eventually develop end-stage kidney disease.

Complications

• Congestive heart failure
• Pulmonary edema
• Chronic glomerulonephritis
• Nephrotic syndrome

Calling your health care provider

Call your health care provider if you have symptoms of acute nephritic syndrome.

Prevention

Many times the disorder cannot be prevented, although treatment of illness and infection may help to reduce the risk.

References

Haymart MR, Atta MG. Glomerular disease. In: Nilsson KR Jr., Piccini JP, eds. The Osler Medical Handbook. 2nd ed. Philadelphia, Pa:Saunders Elsevier;2006:chap 65.

Nachman PH, Jennette JC, Falk RJ. Primary glomerular disease. In: Brenner BM, ed. Brenner & Rector's The Kidney. 8th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 30.

Answer 2

Definition

Acute nephritic syndrome is a group of synptoms that occur with some disorders that cause glomerulonephritis, or swelling and inflammation of the glomeruli in the kidney.

Alternative Names

Glomerulonephritis - acute; Acute glomerulonephritis; Nephritis syndrome - acute

Causes, incidence, and risk factors

Acute nephritic syndrome is often caused by an immune response triggered by an infection or other disease.

Common causes in children and adolescents include:

• Hemolytic uremic syndrome
• Henoch-Schonlein purpura
• IgA nephropathy
• Post-streptococcal glomerulonephritis

Common causes in adults include:

• Abdominal abscesses
• Goodpasture syndrome
• Hepatitis B or C
• Infective endocarditis
• Membranoproliferative GN I
• Membranoproliferative GN II
• Rapidly progressive (crescentic) glomerulonephritis
• SLE or lupus nephritis
• Vasculitis
• Viral diseases such as mononucleosis, measles, mumps

The inflammation affects the function of the glomerulus -- the part of the kidney that filters blood to make urine and remove waste. As a result, blood and protein appear in the urine, and excess fluid builds up in the body.

Swelling of the body occurs when the blood loses a protein called albumin. (Albumin keeps fluid in the blood vessels. When it is lost, fluid collects in the body tissues). Blood loss from the damaged kidney structures leads to blood in the urine.

Acute nephritic syndrome may be related to:

• Acute kidney failure
• High blood pressure

Symptoms

Common symptoms of nephritic syndrome are:

• Blood in the urine (urine appears dark, tea-colored, or cloudy)
• Decreased urine output (little or no urine may be produced)
• Swelling of the face, eye socket, legs, arms, hands, feet, abdomen, or other areas

Other symptoms that may occur include:

• Blurred vision
• Coughcontaining mucus or pink, frothy material
• Decreased alertness, drowsiness, confusion
• General aches and pains (joint pain, muscle aches)
• General ill feeling (malaise)
• Headache
• Shortness of breath
• Slow, sluggish, lethargic movement

Patients may develop symptoms of acute kidney failure or chronic kidney disease.

Signs and tests

During an examination, your health care provider may find the following signs:

• Abnormal heart and lung sounds
• Enlarged liver
• Enlarged neck veins from increased pressure
• General swelling
• High blood pressure
• Signs of acute kidney failure
• Signs of fluid overload (in the abdomen)

Tests that may be done include:

• Blood electrolytes
• Blood urea nitrogen (BUN)
• Creatinine - blood
• Creatinine clearance
• Potassium test
• Protein in the urine
• Urinalysis
• Urine appearance and color

A kidney biopsywill show inflammation of the glomeruli, which may indicate the cause of the condition.

Tests to find the cause of acute nephritic syndrome may include:

• ANA titer (lupus)
• Anti-glomerular basement membrane antibody
• Antineutrophil cytoplasmic antibody for vasculitis (ANCA)
• Blood culture
• Culture of the throat or skin
• Serum complement (C3 and C4)

Treatment

The goal of treatment is to reduce inflammation in the kidney and control high blood pressure. You may need to stay in a hospital to be diagnosed and treated. Treatment may include antibiotics or other medications or therapies.

Your doctor may recommend bedrest. You may need to limit salt, fluids, and potassium in your diet. Your health care provider may prescribe medications to control high blood pressure. Corticosteroids or other anti-inflammatory medications may be used to reduce inflammation.

You may also need other treatments for acute kidney failure.

Support Groups

For information and support, see kidney disease support groups.

Expectations (prognosis)

The outlook depends on the disease that is causing the nephritis. When the condition improves, symptoms of fluid retention (such as swelling and cough) and high blood pressure may go away in 1 or 2 weeks. However, urine tests may take months to return to normal.

Children tend to do better than adults and usually recover completely. Only rarely do they develop complications or progress to chronic glomerulonephritis and chronic kidney disease.

Adults do not recover as well or as quickly as children. Although it is unusual for the disease to return, at least one-third of adults whose disease does return will develop end-stage kidney diseaseand may need dialysis or a kidney transplant.

Complications

• Chronic glomerulonephritis
• Congestive heart failure
• Nephrotic syndrome
• Pulmonary edema

Calling your health care provider

Call your health care provider if you have symptoms of acute nephritic syndrome.

Prevention

Many times the disorder cannot be prevented, although treatment of illness and infection may help to reduce the risk.

References

Appel GB. Glomerular disorders and nephrotic syndromes. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 122.

Nachman PH, Jennette JC, Falk RJ. Primary glomerular disease. In: Brenner BM, ed. Brenner & Rector's The Kidney. 8th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 30.

Reviewed By

Review Date: 09/20/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Herbert Y. Lin, MD, PhD, Nephrologist, Massachusetts General Hospital, Associate Professor of Medicine, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.