NEPHRITIC SYNDROME.Nephritic syndrome is a kidney disorder characterized

Nephritic syndrome is a kidney disorder characterized by:

Key Features:

1. Hematuria (blood in urine)
2. Proteinuria (excess protein in urine)
3. Hypertension (high blood pressure)
4. Azotemia (elevated creatinine and urea)
5. Oliguria (reduced urine output)

1. .
NEPHRITIC SYNDROME
NEPHRITIC SYNDROM
15-Sep-24
PRESENTED
BY
MUTEGEKI ADOLF

2. CONTENTS
●Definition
●Glomerular diseases
●Glomerulonephritis: causes + pathogenesis
●Acute Nephritic Syndrome
●Post streptococcal
glomerulonephritis(PSGN)

3. DEFINITION
●Nephritic syndrome is a kidney disorder characterized by
inflammation of the glomeruli, leading to impaired kidney
function.
●This condition typically presents with hematuria (blood in
the urine), hypertension, and varying degrees of proteinuria
(less severe than in nephroticsyndrome).
●It is often associated with immune-mediated damage to the
kidneys.

4. GLOMERULAR DISEASES
Glomerular diseases include:
-Acute nephritic syndrome
-Rapidly progressive glomerulonephritis
-Nephrotic syndrome
-Chronic nephritis
-Asymptomatic urinary abnormalities(hematuria,
proteinuria or both)

5. GLOMERULONEPHRITIS
Definition: inflammation of
glomeruli

6. CAUSES OF GLOMERULONEPHRITIS
.
Primary GN
Secondary GN(systemic)

7. Causes of glomerulonephritis
.
Primary GN Secondary GN(systemic)
●Acute proliferative GN
●Rapidly progressive(crescentic)
GN
●MCD
●FSGS
●Chronic GN

8. Causes of glomerulonephritis
.
Primary GN Secondary GN(systemic)
●Systemic Lupus Erythematosus
(SLE)
●Diabetes mellitus
●Vasculitis disorders
●amyloidosis

9. Causes of glomerulonephritis
.
Primary GN Secondary GN(systemic)
●Systemic Lupus Erythematosus
(SLE)
●Diabetes mellitus
●Vasculitis disorders
●amyloidosis
●Acute proliferative GN
●Rapidly progressive(crescentic)
GN
●MCD
●FSGS
●Chronic GN

10. 3rd category: hereditary disorders
-Alport syndrome
-Fabry disease
-Thin basement membrane disease

11. Pathogenesis
-It is immune complex-mediated
-Antigen attaches to antibody and forms antigen-antibody
complex(or immune complex)
-This circulates in blood and reaches the glomerulus of kidney
and causes inflammation
-In some cases, antibodies are produced against antigen of
basement membrane -this is called anti-GBM antibody-
induced glomerulonephritis

12. NEPHRITIC SYNDROME KEY FEATURES:
●Hematuria(Blood in the urine):
○Visible or microscopichematuria, with urine appearing
reddish or cola-colored due to the presence of red blood
cells.
○Red blood cell casts are often found in urine microscopy,
which is a hallmark of glomerular damage.
●Proteinuria(Protein in the urine):
○Protein loss in the urine is present but usually less than
3.5 grams/day(milder than in nephroticsyndrome).

13. ●Hypertension(High blood pressure):
○Caused by reduced kidney function, leading to retention of sodium and
water, which increases blood volume.
●Oliguria(Reduced urine output):
○A sign of impaired kidney filtration, where less urine is produced than
normal.
●Azotemia(Elevated blood urea nitrogen and creatinine
levels):
○Due to reduced glomerular filtration rate (GFR), waste products like
urea and creatinine accumulate in the blood.
●Edema:
○Typically mild compared to nephroticsyndrome, usually seen in the
face and around the eyes.

14. Acute Nephritic Syndrome
Syndrome consisting of:
-Oliguria
-Hematuria
-RBC casts in urine
-Hypertension
-Edema
-proteinuria(not severe)
-Azotemia(high blood urea nitrogen)
Post-streptococcal glomerulonephritis(PSGN) is a common cause of
nephritic syndrome

15. ETIOLOGY (CAUSES):
●Nephritic syndrome is often associated with
glomerulonephritis(inflammation of the
glomeruli) and can result from various underlying
conditions, including:
●Infections:
○Post-streptococcal glomerulonephritis: Occurs after a
streptococcal throat or skin infection.
○Infective endocarditis: Bacterial infection of the heart valves
leading to immune complex deposition in the kidneys.

16. ●Autoimmune Disorders:
○Systemic Lupus Erythematosus(SLE): An autoimmune
disease that can cause lupus nephritis, affecting the kidneys.
○IgA Nephropathy (Berger’s Disease): Deposition of IgA
immune complexes in the glomeruli, leading to inflammation.
○Goodpasture’sSyndrome: Autoantibodies attack the
glomerular basement membrane and lungs.
○Granulomatosiswith Polyangiitis(Wegener’s): A type of
vasculitisthat causes inflammation in the kidneys and
respiratory system.

17. ●Vasculitis:
○Diseases like polyarteritisnodosaand
microscopic polyangiitiscan lead to nephritic
syndrome.
●Hereditary Conditions:
○AlportSyndrome: A genetic disorder affecting the
collagen in the glomeruli, leading to progressive
kidney failure, often with hearing and vision
abnormalities.

18. PATHOPHYSIOLOGY:
●In nephritic syndrome, the immune system triggers inflammation
in the glomeruli, leading to:
●Glomerular Damage: Immune complexes or antibodies deposit
in the glomeruli, causing an inflammatory response. This
damages the glomerular filtration barrier, leading to leakage of
blood and proteins into the urine.
●Decreased Glomerular Filtration Rate (GFR): Inflammation
reduces the kidneys' ability to filter blood, causing oliguria and
waste product accumulation in the blood (azotemia).
●Fluid Retention: Sodium and water retention due to impaired
filtration causes hypertension and mild edema.

19. Pathogenesis
Antibodies produced in response to streptococci
↓
Combine with antigen and form antigen-antibody complex
↓
Circulate in blood and get deposited within glomeruli of kidney
↓
Cause inflammation -“glomerulonephritis”

21. Clinical features
●Children between 6-10 years of age
●Malaise, fever, nausea, oliguria
●Classic triad
1. hematuria(smoky or cola-coloured urine)
2. Periorbital edema
3. hypertension
●Other: proteinuria(less than 3.5 g/day)
●In adults: sudden hypertension and elevation of BUN

22. ●Dark-colored urine(cola or tea-colored) due to
hematuria.
●Facial puffinessand periorbitaledema.
●Hypertension(elevated blood pressure).
●Reduced urine output(oliguria).
●Mild to moderate proteinuria.
●Azotemia(elevated serum creatinine and urea).
●Fatigue and weaknessdue to impaired kidney
function.

25. POST STREPTOCOCCAL GLOMERULONEPHRITIS
PSGN
Hematuria
EdemaHypertension

26. Diagnosis
●High Anti-Streptolysin O(ASO) titer
●Low serum complement(C3)
●RFT: Elevated urea and creatinine
●Urinalysis: hematuria, RBC casts, mild proteinuria ☆
●Renal biopsy: acute inflammation in glomerulus with neutrophils
and immunoglobulin deposits

27. ●Urinalysis:
○Microscopy: Presence of red blood cells, often with red blood cell
casts.
○Proteinuria: Moderate protein levels detected in the urine.
●Blood Tests:
○Serum creatinine and BUN (Blood Urea Ntrogen): Elevated due
to impaired kidney function.
○Electrolytes: May show abnormalities such as hyperkalemia or
metabolic acidosis.
○Autoimmune markers: Tests for antinuclear antibodies (ANA),
anti-streptolysinO (ASO), and anti-glomerular basement
membrane antibodies may be indicated based on the suspected
cause.

28. ●Imaging:
○Renal ultrasound: To assess kidney size and
structure.
●Renal Biopsy:
○Performed to confirm the diagnosis and identify the
exact cause of nephritic syndrome. It helps in
distinguishing between different types of
glomerulonephritis.

29. COMPLICATIONS:
●Acute Kidney Injury (AKI): Sudden loss of kidney
function due to severe glomerular inflammation.
●Chronic Kidney Disease (CKD): Progressive loss of
kidney function over time if nephritic syndrome is not
managed effectively.
●Hypertensive Encephalopathy: Severe hypertension
can lead to brain damage, seizures, or coma.
●Heart Failure: Fluid overload and uncontrolled
hypertension can strain the heart, leading to heart failure.

30. Treatment:
●Supportive treatment -rest
●Salt restriction
●Diuretics for edema
●Antihypertensives to control high BP
●Dialysis is done in severe oliguria and
hyperkalemia

31. ●Treatment of nephritic syndrome depends on the
underlying cause and aims to reduce inflammation, control
blood pressure, and manage symptoms:
●Medications:
○Corticosteroids: Used to reduce inflammation in immune-mediated
nephritic syndrome (e.g., lupus nephritis, IgA nephropathy).
○Immunosuppressive drugs: Like cyclophosphamide or azathioprine in
autoimmune causes.
○Antihypertensives: ACE inhibitors, ARBs, and diuretics to control high
blood pressure.
○Antibiotics: If the condition is triggered by a bacterial infection (e.g., post-
streptococcal glomerulonephritis).

32. ●Dietary Modifications:
○Low-sodium diet: To manage fluid retention and
reduce blood pressure.
○Fluid restriction: In cases of severe fluid overload.
●Dialysis:
○In cases of acute kidney injury or severe fluid overload,
dialysis may be required to manage waste products
and fluid balance.

33. Hematuria: Presence of blood in urine
Causes of hematuria:
●Post-streptococcal glomerulonephritis
●Alport syndrome
●IgA nephropathy
●Trauma
●Renal cell carcinoma

34. Proteinuria: presence of protein in urine
Causes of proteinuria:
●Glomerulonephritis
●Diabetic nephropathy
●hypertension

35. Urine findings in glomerulonephritis:
-Oliguria
-Mild proteinuria
-Hematuria (smoky or cola-colored urine)
-Urine microscopy shows RBC casts