Acute nephritic syndrome

Kidney anatomy — The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and stimulating red blood cell production.

Also known as: Glomerulonephritis - acute, Acute glomerulonephritis or Nephritis syndrome - acute

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.

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:

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
Cough containing 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:

A kidney biopsy will 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

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.

Disease

Hepatitis

Hepatitis is swelling and inflammation of the liver. It is not a condition, but is often used to refer to a viral infection of the liver.
Disease

Typhoid fever

Typhoid fever is a bacterial infection characterized by , disease, and a — most commonly caused by the bacteria Salmonella typhi (S. typhi).
Disease

Acute kidney failure

Acute (sudden) kidney failure is the sudden loss of the ability of the kidneys to remove waste and concentrate urine without losing .
Symptoms

Urine - bloody

Blood in your urine, or hematuria, can be classified as microscopic or gross. Microscopic hematuria is when there is very little blood in the urine and it can only be seen with a microscope. Gross hematuria is when there is enough blood in the urine that you can see it with the naked eye. Usually it ...
Disease

Goodpasture syndrome

Goodpasture syndrome is a rare disease that can involve along with lung disease. However, some forms of the disease involve just the lung or kidney, not both.
Disease

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic . SLE may affect the skin, joints, kidneys, and other organs.
Disease

End-stage kidney disease

End-stage kidney disease is the complete, or almost complete failure of the kidneys to function. The main function of the kidneys is to remove wastes and excess water from the body.
Disease

Pulmonary edema

Pulmonary edema is an abnormal build up of fluid in the air sacs of the lungs, which leads to shortness of breath
Disease

Hemolytic-uremic syndrome

Hemolytic-uremic syndrome (HUS) is a disorder that usually occurs when an infection in the digestive system produces toxic substances that destroy red blood cells, causing kidney injury.
Disease

IgA nephropathy

Nephropathy refers to damage, disease , or other abnormalities of the kidney. IgA nephropathy is a kidney disorder in which to a protein called IgA build up in kidney tissue. It is also called Berger’s disease.
Disease

Henoch-Schonlein purpura

Henoch-Schonlein purpura is a disease that involves purple spots on the skin, joint pain, gastrointestinal problems, and (a type of kidney disorder).
Disease

Pneumonia

Pneumonia is a respiratory condition in which there is infection of the lung. Community-acquired pneumonia refers to pneumonia in people who have not recently been in the hospital or another health care facility (nursing home, rehabilitation facility). See also:
Disease

Measles

Measles is a very contagious (easily spread) illness caused by a virus.
Disease

Nephrotic syndrome

Nephrotic syndrome is a group of symptoms including (more than 3.5 grams per day), low blood protein levels, high cholesterol levels, high triglyceride levels, and .
Disease

Mononucleosis

Mononucleosis is a viral infection causing fever, sore throat, and swollen lymph glands, especially in the neck. See also: (acute CMV infection)
Disease

Chronic glomerulonephritis

Chronic glomerulonephritis is the advanced stage of a group of kidney disorders, resulting in inflammation and slowly worsening destruction of internal kidney structures called glomeruli.
Disease

Chronic kidney disease

Chronic kidney disease is the slow loss of kidney function over time. The main function of the kidneys is to remove wastes and excess water from the body.
Disease

Post-streptococcal glomerulonephritis (GN)

Post-streptococcal glomerulonephritis (GN) is a disorder of the kidneys that occurs after infection with certain strains of Streptococcus bacteria.
Disease

Infectious endocarditis

Infectious endocarditis is an infection of the lining of the heart chambers and heart valves that is caused by bacteria, fungi, or other infectious substances. See also:
Disease

Lupus nephritis

Lupus nephritis is a kidney disorder that is a complication of .
Disease

Membranoproliferative GN II

Membranoproliferative glomerulonephritis (GN) type II is a kidney disorder causing decreased kidney function because of inflammation and changes in the tissues of the internal kidney structures.
Disease

Heart failure

Heart failure, also called congestive heart failure, is a condition in which the heart can no longer pump enough blood to the rest of the body.
Disease

Syphilis

Syphilis is infection with the bacteria Treponema pallidum.
Disease

Mumps

Mumps is a contagious disease that leads to painful swelling of the salivary glands. The salivary glands produce saliva, a liquid that moistens food and helps you chew and swallow. See also:
Disease

Allergic vasculitis

Allergic vasculitis is an extreme reaction to a drug, infection, or foreign substance that leads to inflammation and damage to blood vessels of the skin.
Disease

Membranoproliferative GN

Membranoproliferative glomerulonephritis is a kidney disorder that involves inflammation and changes in the microscopic structure of kidney cells. It leads to disrupted kidney function.
Disease

Hypertension

Hypertension is the term used to describe high blood pressure. Blood pressure is a measurement of the force against the walls of your arteries as the heart pumps blood through the body. Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as two numbers — ...
Disease

Abscess

An abscess is a collection of pus in any part of the body that, in most cases, causes swelling and inflammation around it.
Disease

Rapidly progressive glomerulonephritis

Rapidly progressive glomerulonephritis is a form of that causes damage to the small structures (glomeruli) inside the kidneys that help filter waste and fluids from blood to form urine. The disease leads to a rapid loss of kidney function.

Review date:: August 12, 2009
Reviewed by:: Parul Patel, MD, Private practice specializing in Nephrology and Kidney and Pancreas Transplantation, California Pacific Medical Center, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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