WordNet

of critical importance and consequence; "an acute (or critical) lack of research funds"
having or demonstrating ability to recognize or draw fine distinctions; "an acute observer of politics and politicians"; "incisive comments"; "icy knifelike reasoning"; "as sharp and incisive as the stroke of a fang"; "penetrating insight"; "frequent penetrative observations" (同)discriminating, incisive, keen, knifelike, penetrating, penetrative, piercing, sharp
extremely sharp or intense; "acute pain"; "felt acute annoyance"; "intense itching and burning" (同)intense
having or experiencing a rapid onset and short but severe course; "acute appendicitis"; "the acute phase of the illness"; "acute patients"
of an angle; less than 90 degrees
a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"
affected by nephritis
of or relating to the kidneys (同)renal

PrepTutorEJDIC

(先の)『鋭い』,とがった / (痛み・感情などが)『激しい』,強い / (知力・感覚などが)『鋭い』,鋭敏な / (事態が)重大な / (病気が)急性の / (音が)高い,鋭い / 鋭角の
(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/23 08:47:19」(JST)

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Nephritic syndrome (or acute nephritic syndrome)^[1] is a collection of signs (known as a syndrome) associated with disorders affecting the kidneys, more specifically glomerular disorders.^[2] It is characterized by having a thin glomerular basement membrane and small pores in the podocytes of the glomerulus, large enough to permit proteins (proteinuria) and red blood cells (hematuria) to pass into the urine. By contrast, nephrotic syndrome is characterized by only proteins (proteinuria) moving into the urine. Nephritic syndrome, like nephrotic syndrome, may involve hypoalbuminemia due to protein albumin moving from the blood to the urine.

Hematuria can be caused by bleeding anywhere in the urinary tract, but if the RBCs are trapped in urinary casts, it is more likely that the bleeding originated in the nephron, and nephritic syndrome becomes more probable.

It is usually distinguished from nephrotic syndrome, but sometimes the two are described as associated in a minority of cases (occasionally — and confusingly— referred to as "nephritic/nephrotic," although this is considered a progression of a nephritic syndrome and categorically not a nephrotic syndrome).^[3] Some conditions can cause either syndrome, and both syndromes can have a similar appearance upon biopsy. Neither term represents a definitive diagnosis, but both terms can be useful in the early stages of a differential diagnosis.

Signs and symptoms

Nephritic syndrome is characterized by;

hematuria (blood in the urine), with red blood cell (RBC) casts present in the urine
proteinuria (protein in the urine) - small amounts of protein are lost in the urine, but this is usually trivial (<3.5 g/day)
hypertension^[4] (high blood pressure)- mild
uremia - due to retention of waste products

and variable renal insufficiency, with;

azotemia (elevated blood nitrogen)
oliguria (low urine output <400 mL/day)

The main features are hypertension and RBC casts. The proteinuria in nephritic syndrome is not usually severe, but may occasionally be heavy enough to be in the range usually found in nephrotic syndrome.

Diagnosis

Nephritic syndrome is not a specific diagnosis. It is a clinical syndrome and characterized by the above signs.

An anti-streptolysin O titre (or ASOT) is typically done to test for exposure to streptococci. This test however has very poor specificity.

Differential diagnosis

The two classic diagnoses of nephritic syndrome are:

post-streptococcal glomerulonephritis
crescentic glomerulonephritis (also called rapidly progressive glomerulonephritis)

Nephritic syndrome causes are usually grouped into 'focal proliferative' and 'diffuse proliferative' on the basis of histology (obtained by a renal biopsy).

Focal proliferative

IgA nephropathy
chronic liver failure
Celiac sprue
dermatitis herpetiformis
Henoch-Schoenlein purpura
Alport syndrome
SLE

Diffuse proliferative

membranoproliferative glomerulonephritis (malaria, hepatitis C, chronic infection, sickle-cell disease, SLE, hemolytic uremic syndrome/thrombotic thrombocytopenic purpura)
cryoglobulinemia
SLE
rapidly progressing glomerulonephritis (RPGNs) - several.

Treatment

Treatment is dependent on the underlying etiology (cause) and the degree of kidney dysfunction.

Prognosis

Because nephritic syndrome is not a disease, just a collection of symptoms, the prognosis depends on the underlying etiology.

References

^ "acute nephritic syndrome" at Dorland's Medical Dictionary
^ http://www.merck.com/mmpe/sec17/ch235/ch235b.html
^ "Acute Nephritic Syndrome". Retrieved 2011-06-05.
^ "ELECTRONIC LEARNING MODULE for KIDNEY and URINARY TRACT DISEASES". Retrieved 2008-11-26.

External links

Acute nephritic syndrome - medlineplus.org
Nephritic syndrome - A to Z topics.
Nephritic syndrome - Merck Manual.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 糸球体疾患の鑑別診断および評価 differential diagnosis and evaluation of glomerular disease
2. 小児における糸球体腎炎の病因と原因の概要 overview of the pathogenesis and causes of glomerulonephritis in children
3. 溶連菌感染後糸球体腎炎 poststreptococcal glomerulonephritis
4. 急速進行性（半月形）糸球体腎炎の分類および治療の概要 overview of the classification and treatment of rapidly progressive crescentic glomerulonephritis
5. C3糸球体腎症：デンスデポジット病およびC3糸球体腎炎 c3 glomerulopathies dense deposit disease and c3 glomerulonephritis

English Journal

Drug-induced kidney disease: a study of the Japan Renal Biopsy Registry from 2007 to 2015.

Yokoyama H1, Narita I2, Sugiyama H3, Nagata M4, Sato H5, Ueda Y6, Matsuo S7.
Clinical and experimental nephrology.Clin Exp Nephrol.2015 Nov 21. [Epub ahead of print]
INTRODUCTION: The Japan Renal Biopsy Registry (J-RBR) was started in 2007 by the Committee for the Standardization of Renal Pathological Diagnosis and the Committee for the Kidney Disease Registry of the Japanese Society of Nephrology. The purpose of this report is to clarify drug-induced kidney dis
PMID 26590949

Clinical Characteristics and Outcome of Post-Infectious Glomerulonephritis in Children in Southern India: A Prospective Study.

Gunasekaran K1, Krishnamurthy S2, Mahadevan S1, Harish BN3, Kumar AP4.
Indian journal of pediatrics.Indian J Pediatr.2015 Oct;82(10):896-903. doi: 10.1007/s12098-015-1752-0. Epub 2015 Apr 18.
OBJECTIVES: To evaluate the clinical characteristics, complications and outcome of post-infectious glomerulonephritis (PIGN).METHODS: This prospective observational study was conducted from January 2013 through July 2014 at a tertiary care hospital in south India. Post-streptococcal glomerulonephrit
PMID 25893528

Glomerular Diseases Associated With Hepatitis B and C.

Gupta A1, Quigg RJ2.
Advances in chronic kidney disease.Adv Chronic Kidney Dis.2015 Sep;22(5):343-51. doi: 10.1053/j.ackd.2015.06.003.
Infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) are prevalent worldwide. In this review, we discuss the epidemiology, pathogenesis, clinical manifestations, and treatment of HBV- and HCV-related glomerulonephritis (GN). The most common histopathologic presentation of HBV-GN is HB
PMID 26311595

Japanese Journal

急速進行性腎炎症候群・ネフローゼ症候群と急性腎不全

日本内科学会雑誌 99(5), 984-989, 2010-05-10
NAID 10026331368

急性腎炎症候群 (小児の治療指針) -- (腎・尿路)

小児科診療 73(-), 663-665, 2010
NAID 40017118253

魚骨による消化管穿孔症例の検討

日本腹部救急医学会雑誌 = Journal of abdominal emergency medicine 27(3), 441-446, 2007-03-31
NAID 10019484549

Related Pictures

★リンクテーブル★

リンク元	「急性糸球体腎炎」「急性腎炎症候群」「腎炎症候群」「acute glomerulonephritis」
関連記事	「acute」「nephritic」「syndrome」

「急性糸球体腎炎」

Nephritic syndrome
Classification and external resources
Specialty	urology
ICD-10	N00, N01, N03, N05
ICD-9-CM	580
MedlinePlus	000495

　　[★]

英: acute glomerulonephritis、AGN
同: 急性腎炎 acute nephritis
関: 管内増殖性糸球体腎炎、急性腎炎症候群 acute nephritic syndrome

概念

急性腎炎症候群を示す代表的疾患
先行感染後、いくらかの潜伏期を経たあとに発症し、急性腎炎症候群の症状を呈する(血尿、蛋白尿、GFR低下、浮腫、高血圧など)

A群β溶血性連鎖球菌が先行感染の場合、潜伏期は10日(1-2)

免疫複合体を形成するタイムラグである。

疫学

3-10歳に好発。男児に多い(男女=2:1)。高齢者でもありうる

病因

Streptococcus pyogenes(A群β溶血性連鎖球菌)による咽頭炎(上気道炎)・膿痂疹に続発
連鎖球菌の菌体成分が腎臓と交差反応するため(交通抗原を有するため)、糸球体基底膜と抗体抗原反応を起こし炎症反応を起こす

A群β溶連菌(12型)が一番多い。

病理

管内性増殖性糸球体腎炎

びまん性増殖性腎炎：C3, IgGの沈着、Hump形成

[show details]

症状

3主徴(血尿・浮腫・高血圧)

検査

溶連菌の場合、ASO, ASKの上昇。
補体価：一過性低下　→　持続するときは膜性増殖性糸球体腎炎 or ループス腎炎

症例

096D036

「急性腎炎症候群」

　　[★]

英: acute nephritic syndrome
同: 急性糸球体腎炎症候群 acute glomerulonephritic syndrome
関: 急性糸球体腎炎

定義 YN.E-40、医学大事典

WHO臨床症候分類(1995年改訂)に定められる臨床的特徴を示す病態の総称
突然に血尿、蛋白尿、GFR低下、高血圧、ナトリウム・水の貯留(浮腫、心不全)などを示して発症する病態。

急性腎炎症候群に分類される疾患 YN.E-40

感染後に発症	溶連菌感染後急性糸球体腎炎
感染後に発症	非溶連菌性急性糸球体腎炎(肺炎球菌、ブドウ球菌、ウイルスなど)
慢性糸球体腎炎の急性増悪	IgA腎症
慢性糸球体腎炎の急性増悪	慢性増殖性糸球体腎炎
急速進行性糸球体腎炎
全身疾患に伴うもの	ループス腎炎
全身疾患に伴うもの	紫斑病性腎炎