Nephritic Syndrome

What is Nephritic Syndrome?

The nephritic syndrome is a medical condition that includes symptoms like the presence of blood in the urine, high blood pressure, reduced urine production and swelling in the body. Essentially, this condition arises from an inflammation of the glomerulus – a tiny structure in your kidneys – resulting in nephritic syndrome. This inflammation can lead to the sudden presence of red blood cells and blood cells cast off in the urine, differing amounts of protein in the urine, and white blood cells in the urine. The main cause of this condition can either be from a problem in the kidneys themselves, or it could be as a result of other disorders affecting the entire body.

What Causes Nephritic Syndrome?

Nephritic syndrome is a condition often associated with a type of kidney inflammation called proliferative glomerulonephritis. This inflammation can occur due to acute (sudden) immune reactions in the kidneys after an infection, a specific kind of inflammation forming crescent-shaped scars, or a similar inflammation that happens in a disease called lupus.

In children, the most typical cause of this sudden kidney inflammation is after a strep throat infection or a skin infection known as impetigo. The symptoms of nephritic syndrome usually show up seven to ten days after a strep throat infection or two to three weeks after a skin infection. The most common culprit behind this is a type of bacteria named group A-beta hemolytic streptococci, but only specific strains can cause the disease. Mostly, infections with three types of this bacteria, namely 12, 4, and 1, are found to precede the disease.

A similar form of kidney inflammation can happen following various infections, including specific bacterial infections (like meningitis caused by meningococci bacteria, infection of the heart lining caused by staphylococci, pneumonia caused by pneumococci), viral infections (like hepatitis B and C, mumps, HIV, chickenpox, mono), and parasitic infections (like malaria and toxoplasmosis).

There’s a particular form called crescentic or rapidly progressive glomerulonephritis, which leads to sudden, severe kidney failure. However, this type does not have a specific cause. It can be due to one of several conditions: antibody-mediated disease, immune complex diseases leading to deposits of immune cells and proteins, or inflammation associated with blood vessel inflammation in the kidney itself or the whole body.

In severe cases of a disease called systemic lupus erythematosus (SLE), patients with a particular type of kidney inflammation can also present with nephritic syndrome.

Risk Factors and Frequency for Nephritic Syndrome

The final report from the National Center of Health Statistics highlighted nephritis syndrome, combined with nephrotic syndrome, as the 9th most common cause of death in the US in 2017. In that year, deaths from these conditions, along with renal diseases, accounted for 50,633 out of a total of 2,813,503 deaths.

It was also noted that the risk of dying from these conditions increases as people get older. The report showed that more women died from nephritic and nephrotic syndrome than men. For women, it represented the 9th most common cause of death, accounting for 1.8% of all deaths. However, for men, it did not rank in the top ten causes of death.

Signs and Symptoms of Nephritic Syndrome

Nephritic syndrome is a kidney condition that can show various symptoms. Here are the most common ones:

Swelling around the eyes and in the feet
Reddish or cola-colored urine due to red blood cells
Protein in the urine in non-high amounts, which may cause foamy urine
High or difficult-to-control blood pressure
Kidney problems, which can lead to less urine output and higher levels of waste products in the blood

The progression of these symptoms can differ from person to person. Some people may experience a slow, gradual worsening of symptoms leading to chronic kidney failure. Others may have a quick onset of symptoms that get better on their own. And in some severe cases, symptoms can develop very quickly and aggressively.

Your doctor may ask you questions like:

Do you have puffiness around your eyes in the morning?
Are your legs swollen in the evening?
Has the color, smell, consistency, or amount of your urine changed?
Have you had a recent respiratory or skin infection?
Are you experiencing fever or fatigue?
Do you have any skin ulcers or rashes on your arms or legs?
Do you have coughing or shortness of breath? Those symptoms could signal a more serious condition.

Furthermore, physical examination may reveal that the patient is pale and has anemia. It’s also common for patients to have high blood pressure. In some cases, there might be signs of fluid overload such as swelling, accumulation of fluid in the lungs causing crackling sounds when breathing, and increased jugular vein pressure. A new heart murmur might be heard on examination if the patient has an infection of the heart valves. These patients might also show signs of skin purpura (purple-colored spots or patches on the skin), as well as painful and swollen joints. These signs are often seen in patients with systemic diseases like vasculitis, Henoch-Schönlein purpura, and systemic lupus erythematosus (SLE).

Testing for Nephritic Syndrome

The first test done when checking for nephritic syndrome, a type of kidney disease, is a urine analysis. This helps to study the qualities of your urine like its color, which can change due to exercise, certain foods, or medications. Normally, it’s fine for there to be a small amount of blood in the urine, specifically up to 3 red blood cells per high power field (a unit of measurement in microscopy).

However, in nephritic syndrome, the urine usually contains more than 5 red blood cells per high power field, along with abnormal red blood cells, acanthocytes (spiky red blood cells), and in some cases, white blood cells. This typically results in a brownish color of the urine – similar to the color of cola. The presence of unusual cells in the urine is a sign of blood in the urine from the kidneys. Patients also tend to have an increased number of white blood cells in their urine even when they don’t have a urinary tract infection. Although, these unusual cells are less common in your urine than acanthocytes unless the disease is severe.

Also in nephritic syndrome, there might be a high level of protein in the urine. This should be confirmed with a 24-hour urine protein test if nephritic syndrome is suspected. High levels of protein in urine is typically another sign of kidney disease.

To further understand the condition of the kidneys, the doctor would also measure the levels of creatinine and urea, waste products, in your blood. With nephritic syndrome, the kidneys aren’t able to get rid of urea and creatinine as efficiently, resulting in increased levels of these in your blood and a decreased glomerular filtration rate (GFR, a measurement of how well the kidneys are cleaning the blood). If you have persistent fever and signs of an ongoing infection, your doctor might also decide to obtain blood cultures to check for bacteria in the blood.

The definitive method to know the cause of your nephritic syndrome would be a kidney biopsy. This involves taking a small piece of your kidney tissue to examine it closely, possibly under a microscope.

There are also some blood tests that can be performed to rule out other potential causes of kidney disease, which include: ANA to check for autoimmune disorders, Serum C3 and C4 Complement Levels to test for levels of inflammation, ASO Titers to indicate a recent streptococcal infection, ANCA to rule out systemic vasculitis (a condition that causes blood vessels to swell), Anti-dsDNA Antibodies to diagnose systemic lupus erythematosus (an autoimmune disease), Anti-glomerular Basement Membrane Antibodies to rule out Goodpasture syndrome (a rare autoimmune disease), Hepatitis B Surface Antigen and HCV Antibodies to rule out hepatitis B and C infection, Serum Protein Electrophoresis and Serum Immunofixation to identify plasma cell disorders, and Rheumatoid Factor to screen for cryoglobulinemia (the presence of abnormal proteins in the blood) in suspected patients.

Treatment Options for Nephritic Syndrome

Nephritic syndrome is a kidney condition that we usually manage with supportive treatments. Here’s a look at how that works:

– To manage blood pressure: If you have high blood pressure despite controlling your salt intake, limiting fluids, and taking a certain type of medication known as loop diuretics, we might suggest blood pressure medication like ACE inhibitors or ARBs. In severe cases, nifedipine may be used.

– To control fluid buildup: Loop diuretics are often used to help your body get rid of extra salt and water. This can help to decrease the amount of fluid in your body and can make your kidney’s recovery process easier.

– To reduce inflammation: Corticosteroids are used to reduce inflammation in the kidneys, which can help them heal.

– To regulate the immune response: Certain drugs called immunosuppressives can decrease or block the effects of the agents that caused the condition in the first place. These are very useful for a form of nephritic syndrome called rapidly progressive glomerulonephritis. However, these treatments can be controversial in some cases of nephritic syndrome, such as when it is caused by a type of bacteria called staphylococcus. Using these drugs can potentially lead to a severe whole-body infection and is linked with higher death rates.

– Antibiotics: If you have a form of the condition called post-streptococcal GN and there’s evidence of a bacterial infection, you might be given penicillin or, if you’re allergic to penicillin, erythromycin. If we treat the bacterial infection early with antibiotics, it’s often possible to lessen the severity and occurrence of kidney inflammation.

– Dialysis: In some cases, nephritic syndrome progresses quickly and can lead to kidney failure. In this situation, we would undertake kidney replacement therapy, which usually means dialysis. This is a treatment where a machine does some of the work your kidneys would do if they were healthy.

Diseases of the kidneys can often look similar to nephritic syndrome. These conditions may include:

Nephrotic syndrome, another kidney disorder
Familial nephritis, a hereditary disease affecting the kidneys
Idiopathic hematuria, unexplained blood in the urine
Anaphylaxis, a serious allergic reaction

Recognizing the differences between these conditions is key to making an accurate diagnosis.

What to expect with Nephritic Syndrome

The outlook for people with nephritic syndrome, a kidney disease, greatly depends on the cause behind the disease as well as the age of the patient. In most cases, children experience a brief episode of glomerulonephritis, an inflammation of the kidneys, which gets better on its own and thus, their outlook is generally good. However, adults often have a more severe, long-lasting form of the disease. In fact, in about 20% to 74% of adult patients, the disease doesn’t get better on its own.

In these patients, the impairment of kidney function continues and can ultimately lead to chronic kidney failure, which is a long-term condition where the kidneys lose their ability to adequately filter harmful substances from the blood.

Possible Complications When Diagnosed with Nephritic Syndrome

Nephritic syndrome can seriously affect kidney function, leading to several health complications, such as:

Acute kidney failure which can worsen to rapidly progressive glomerulonephritis (RPGN), a condition where the kidneys quickly stop working
Uncontrolled high blood pressure
Azotemia, where there’s too much nitrogen waste in the blood
Hyperkalemia, or high levels of potassium in your blood
Hyperphosphatemia, or too much phosphate in the blood
Hypocalcemia, or low calcium levels in the blood
Heart failure
Hypertensive encephalopathy which can cause seizures and changes in consciousness

Preventing Nephritic Syndrome

Here are some recommendations for managing your health:

Dietary changes: It’s advisable for patients to consume a diet that’s low in sodium (salt) and potassium. Decreasing your intake of these substances helps your body get rid of excess water more efficiently.

Liquid intake: To help ease any existing swelling and reduce the chances of more swelling (also known as edema), it’s recommended to limit your fluid intake. This doesn’t mean you should stop drinking water completely, but rather be mindful of the amount you’re drinking.

Limited movement: Patients are advised to limit their physical activity while they’re being treated. This means you should cut back on excessive exercise and exertion, ensuring your body can devote its energy to healing.

Frequently asked questions

The prognosis for nephritic syndrome depends on the cause of the disease and the age of the patient. In children, the outlook is generally good as they often experience a brief episode of glomerulonephritis that gets better on its own. However, in adults, the disease is often more severe and long-lasting, with about 20% to 74% of adult patients not experiencing improvement. In these cases, the impairment of kidney function can lead to chronic kidney failure.

Nephritic syndrome can occur due to acute immune reactions in the kidneys after an infection, a specific kind of inflammation forming crescent-shaped scars, or a similar inflammation that happens in a disease called lupus. It can also happen following various infections, including bacterial, viral, and parasitic infections. In severe cases of systemic lupus erythematosus (SLE), patients can also present with nephritic syndrome.

The signs and symptoms of Nephritic Syndrome include: - Swelling around the eyes and in the feet. - Reddish or cola-colored urine due to red blood cells. - Protein in the urine in non-high amounts, which may cause foamy urine. - High or difficult-to-control blood pressure. - Kidney problems, which can lead to less urine output and higher levels of waste products in the blood. The progression of these symptoms can vary from person to person. Some individuals may experience a slow, gradual worsening of symptoms leading to chronic kidney failure, while others may have a quick onset of symptoms that improve on their own. In severe cases, symptoms can develop rapidly and aggressively. In addition to these common symptoms, a doctor may ask specific questions to assess the condition further. These questions may include asking about puffiness around the eyes in the morning, swelling in the legs in the evening, changes in urine color, smell, consistency, or amount, recent respiratory or skin infections, fever or fatigue, presence of skin ulcers or rashes on the arms or legs, and symptoms like coughing or shortness of breath, which could indicate a more serious condition. Physical examination may reveal additional signs such as paleness and anemia in the patient. High blood pressure is also commonly observed. Signs of fluid overload, such as swelling and crackling sounds in the lungs, may be present. Increased jugular vein pressure and the presence of a new heart murmur may indicate an infection of the heart valves. Patients with Nephritic Syndrome might also exhibit signs of skin purpura (purple-colored spots or patches on the skin) and painful, swollen joints, which are often seen in systemic diseases like vasculitis, Henoch-Schönlein purpura, and systemic lupus erythematosus (SLE).

The types of tests that are needed for Nephritic Syndrome include: - Urine analysis to study the qualities of urine, such as color and presence of abnormal cells - 24-hour urine protein test to confirm high levels of protein in the urine - Measurement of creatinine and urea levels in the blood to assess kidney function - Blood cultures to check for bacteria in the blood if there are signs of infection - Kidney biopsy to examine kidney tissue closely - Additional blood tests to rule out other potential causes of kidney disease, such as autoimmune disorders, inflammation levels, streptococcal infection, vasculitis, lupus erythematosus, Goodpasture syndrome, hepatitis B and C infection, plasma cell disorders, and cryoglobulinemia.

The other conditions that a doctor needs to rule out when diagnosing Nephritic Syndrome are: - Nephrotic syndrome - Familial nephritis - Idiopathic hematuria - Anaphylaxis

When treating Nephritic Syndrome, there can be several side effects. These include: - Severe whole-body infection and higher death rates when using immunosuppressive drugs, particularly in cases caused by staphylococcus bacteria. - Potential allergic reactions to penicillin, which is used to treat post-streptococcal GN. - Possible occurrence of kidney failure, leading to the need for kidney replacement therapy such as dialysis. - Various health complications, including acute kidney failure, uncontrolled high blood pressure, azotemia, hyperkalemia, hyperphosphatemia, hypocalcemia, heart failure, and hypertensive encephalopathy.

A nephrologist.

Nephritic syndrome is the 9th most common cause of death in the US in 2017.

Nephritic Syndrome is treated with supportive treatments such as blood pressure medication, loop diuretics to control fluid buildup, corticosteroids to reduce inflammation in the kidneys, immunosuppressives to regulate the immune response, antibiotics to treat bacterial infections, and dialysis in cases of kidney failure.

Nephritic Syndrome is a medical condition characterized by symptoms such as blood in the urine, high blood pressure, reduced urine production, and swelling in the body. It is caused by inflammation of the glomerulus in the kidneys, resulting in the presence of red blood cells, protein, and white blood cells in the urine.