| Nephritic syndrome |
| Classification and external resources |
| ICD-10 |
N00, N01, N03, N05 |
| ICD-9 |
580 |
| MedlinePlus |
000495 |
Not to be confused with nephrotic syndrome.
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.
Contents
- 1 Signs and symptoms
- 2 Diagnosis
- 3 Differential diagnosis
- 3.1 Focal proliferative
- 3.2 Diffuse proliferative
- 4 Treatment
- 5 Prognosis
- 6 References
- 7 External links
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 B, 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.
- Urinary system
- Pathology
- Urologic disease / Uropathy (N00–N39, 580–599)
|
|
| Abdominal |
Nephropathy/
(nephritis+
nephrosis) |
Glomerulopathy/
glomerulitis/
(glomerulonephritis+
glomerulonephrosis) |
Primarily
nephrotic |
| Non-proliferative |
- Minimal change
- Focal segmental
- Membranous
|
|
| Proliferative |
- Mesangial proliferative
- Endocapillary proliferative
- Membranoproliferative/mesangiocapillary
|
|
| By condition |
|
|
|
Primarily
nephritic,
RPG |
| Type I RPG/Type II hypersensitivity |
|
|
| Type II RPG/Type III hypersensitivity |
- Post-streptococcal
- Lupus
- IgA/Berger's
|
|
| Type III RPG/Pauci-immune |
- Granulomatosis with polyangiitis
- Microscopic polyangiitis
- Churg–Strauss syndrome
|
|
|
|
Tubulopathy/
tubulitis |
| Proximal |
|
|
| Thick ascending |
|
|
| Distal convoluted |
|
|
| Collecting duct |
- Liddle's syndrome
- RTA
- Diabetes insipidus
|
|
| Renal papilla |
|
|
| Major calyx/pelvis |
- Hydronephrosis
- Pyonephrosis
- Reflux nephropathy
|
|
| Any/all |
|
|
|
| Interstitium |
- Interstitial nephritis
- Pyelonephritis
- Danubian endemic familial nephropathy
|
|
| Any/all |
| General syndromes |
- Renal failure
- Acute renal failure
- Chronic kidney disease
- Uremic pericarditis
- Uremia
|
|
| Vascular |
- Renal artery stenosis
- Renal ischemia
- Hypertensive nephropathy
- Renovascular hypertension
- Renal cortical necrosis
|
|
| Other |
- Analgesic nephropathy
- Renal osteodystrophy
- Nephroptosis
- Abderhalden–Kaufmann–Lignac syndrome
|
|
|
|
| Ureter |
- Ureteritis
- Ureterocele
- Megaureter
|
|
|
| Pelvic |
| Bladder |
- Cystitis
- Interstitial cystitis
- Hunner's ulcer
- Trigonitis
- Hemorrhagic cystitis
- Neurogenic bladder dysfunction
- Bladder sphincter dyssynergia
- Vesicointestinal fistula
- Vesicoureteral reflux
|
|
| Urethra |
- Urethritis
- Non-gonococcal urethritis
- Urethral syndrome
- Urethral stricture/Meatal stenosis
- Urethral caruncle
|
|
|
| Any/all |
- Obstructive uropathy
- Urinary tract infection
- Retroperitoneal fibrosis
- Urolithiasis
- Bladder stone
- Kidney stone
- Renal colic
- Malakoplakia
- Urinary incontinence
|
|
Index of the urinary system
|
|
| Description |
- Anatomy
- Physiology
- Development
- Cells
|
|
| Disease |
- Electrolyte and acid-base
- Congenital
- Neoplasms and cancer
- Other
- Symptoms and signs
- Urine tests
- Blood tests
|
|
| Treatment |
- Procedures
- Drugs
- Intravenous fluids
|
|
|