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Nephritic Syndrome – Causes, Symptoms and Treatment

Nephritic syndrome is a kidney condition characterized by blood in the urine, high blood pressure, and reduced kidney function, typically caused by inflammation of the kidney filters.

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Things worth knowing about "Nephritic Syndrome"

Nephritic syndrome is a kidney condition characterized by blood in the urine, high blood pressure, and reduced kidney function, typically caused by inflammation of the kidney filters.

What is Nephritic Syndrome?

Nephritic syndrome is a clinical condition caused by inflammation of the glomeruli – the tiny filtering units of the kidney. This inflammation disrupts the normal filtration barrier, allowing blood and protein to leak into the urine. The condition can present acutely or follow a chronic course and must be clearly distinguished from the similarly named nephrotic syndrome.

Causes

Nephritic syndrome can result from various conditions that lead to inflammation of the glomeruli, collectively referred to as glomerulonephritis. Common causes include:

Infections: Post-streptococcal glomerulonephritis is particularly common, occurring weeks after infection with certain streptococcal bacteria (e.g., following strep throat or scarlet fever).
Autoimmune diseases: Conditions such as systemic lupus erythematosus (lupus nephritis) or Goodpasture syndrome can attack the glomeruli.
IgA nephropathy (Berger disease): Deposits of the antibody IgA in the glomeruli trigger inflammatory reactions.
Vasculitis: Inflammatory vessel diseases such as ANCA-associated vasculitis can affect the kidneys.
Hereditary causes: Alport syndrome involves a genetic defect in the collagen of the filtration membrane.

Symptoms

Nephritic syndrome is characterized by a typical combination of clinical features:

Hematuria: Blood in the urine is the hallmark symptom. The urine may appear visibly reddish-brown (resembling cola or tea), or blood may only be detectable under a microscope.
Proteinuria: Protein in the urine, usually in moderate amounts (less than 3.5 g per day, in contrast to nephrotic syndrome).
Hypertension: High blood pressure arises from reduced sodium excretion and activation of the renin-angiotensin-aldosterone system.
Edema: Fluid retention, particularly around the eyes (periorbital edema) and in the legs.
Reduced kidney function: Elevated creatinine and urea levels in the blood indicate impaired glomerular filtration.
Oliguria: Reduced urine output as a sign of diminished kidney function.

Diagnosis

The diagnosis of nephritic syndrome is based on a combination of clinical assessment, laboratory tests, and imaging:

Urinalysis: The presence of red blood cells and red blood cell casts in the urine is diagnostic. Protein levels in the urine are also measured.
Blood tests: Assessment of creatinine, urea, complement levels (C3, C4), antibodies (e.g., ANCA, anti-GBM, ANA), and streptococcal antibodies (ASO titer).
Kidney biopsy: A tissue sample from the kidney is often necessary to determine the exact cause of glomerulonephritis and guide appropriate treatment.
Imaging: Renal ultrasound to assess size and structure of the kidneys.

Treatment

Treatment of nephritic syndrome depends on the underlying cause and severity of the condition:

General Measures

Restriction of salt and fluid intake in cases of edema and hypertension.
Blood pressure control, preferably with ACE inhibitors or angiotensin receptor blockers (ARBs), which also provide kidney protection.
Diuretics to manage fluid retention.

Cause-Specific Therapy

Post-streptococcal glomerulonephritis: Antibiotics to treat the underlying infection; the condition typically resolves completely in children.
Autoimmune diseases: Immunosuppressants such as corticosteroids (e.g., prednisolone), cyclophosphamide, or mycophenolate mofetil are used to suppress the immune response.
Goodpasture syndrome: Plasmapheresis (removal of harmful antibodies from the blood) combined with immunosuppressive therapy.
IgA nephropathy: Supportive therapy or immunosuppression depending on disease progression.

Advanced Kidney Failure

In severe or chronic cases, renal replacement therapy (dialysis) or long-term kidney transplantation may become necessary.

Distinction from Nephrotic Syndrome

Nephritic syndrome is often confused with nephrotic syndrome. Both involve the glomeruli, but they differ significantly: nephrotic syndrome is characterized by massive proteinuria (over 3.5 g/day), severe edema, and low blood protein levels, with less prominent hypertension and hematuria. In contrast, nephritic syndrome is dominated by blood in the urine, hypertension, and impaired kidney function.

References

Kasper D. L. et al. - Harrison's Principles of Internal Medicine, 21st edition, McGraw-Hill Education (2022).
Kidney Disease: Improving Global Outcomes (KDIGO) - Clinical Practice Guideline for Glomerulonephritis. Kidney International Supplements, 2(2), 2012. Available at: https://kdigo.org
Floege J., Johnson R. J., Feehally J. - Comprehensive Clinical Nephrology, 6th edition, Elsevier (2019).

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