Nephritic Syndrome Flashcards
what is nephritic syndrome?
clinical syndrome from the inflammation of the glomerulus resulting in a blockage of larger protein complexes due to glomerular deposition or in situ formation of immune complexes
basically there is a level of acute kidney injury (with the increased creatinine)
what is H.E.E.D. in the context of nephritic syndrome?
- hematuria
- elevated BP/creatinine
- edema
- decreased urine output (bc renal insufficiency)
what type of condition is more common in nephritic?
autoimmune
in what popualtion is the incidence highest for nephritic syndrome?
children 5-15Y
what are some common etiologies for nephritic syndrome? I have 8, list 4
- Most common in children: post-streptococcal (post-infectious) glomerulonephritis –> acute proliferative glomerulonephritis
- IgA nephropathy
- Lupus
- Goodpasture’s syndrome (anti-GBM)
- ANCA vasculitis/Pauci immune (no immune complexes/anti-GBM)
- IgA-associated vasculitis
- Alport syndrome (nephritic + deafness or eye s/s)
- Crescentic or rapidly progressive glomerulonephritis
what is the general pathophys for hematuria in nephritic syndrome?
massive inflammatory response to a variety of etiologic agents –> local vasodilation –> glomerular inflammation and injury –> porous podocytes –> RBCs spill over into urine
why is HTN more of a presenting s/s in nephritic syndrome vs nephrotic syndrome?
because in nephrotic there is no decreased perfusion of blood to the kidneys, so no activation of RAAS
in nephritic there is local vasodilation which makes the kidneys think there is a decreased BP, so RAAS gets activated resulting in a systemic response to increase BP
What are some s/s for nephritic syndrome?
- macroscopic hematuria
- edema - more so nephrotic
- HTN
- renal insufficiency –> low GRF bc vasodilation and inflammation resulting in oliguria and anuria
- fever – etiology dependant
- azotemia - urea build up
- non-nephrotic proteinuria
what physical exam/hx findings would we look for/do/ask for nephritic syndrome?
- CVA tenderness - r/o other kidney inflam diseases
- fluid exam
- oral exam - look for s/s of strep - inflammed tonsels and exudates, lack of cough
- lupus/joint exam - butterfly rash
- hx of recent infection
- FH of autoimmune disease
what urinalysis would you do for a nephritic work up?
- need to r/o nephortic syndrome - albumin:creatinine ratio
- dipstick: proteinuria, hematuria, pyuria
- urine culture r/o UTI
- 24h urine collection to r/o nephrotic syndrome
what labwork would you run to determine nephritic syndrome + underlying etiology?
general labwork
- CBC
- serum creatinine
- electrolytes + extended lytes
- PT/INR
etiology labwork
- complement protein 3 and 4 (C3 and 4) - gives idea of hx of infection or other autoimmune but nonspecific
- blood culture - r/o sepsis
- anti-GBM - Good Pasture’s syndrome
- autoimmune (lupus-ANA, vasculitis-ANCA, IgA/IgG serum levels)
when do you need to do imaging for nephritic syndrome?
to check for ddx - U/S or CT renal
what is the definitive ix for nephritic syndrome?
biopsy!
how to treat/manage nephritic syndrome?
- refer to nephrology
- treat underlying cause (post-infectious usually self-limiting, could consider abx; lupus, IgA, and nephropathy give steroids)
- supportive care (HTN - ACEi/ARBs for chronic cases and salt restriction; edema - loop diuretics)
- plasmaphesis - for autoimmune conditions and Good Pasture’s syndrome (anti-GBM)
- pt education - NSAID avoidance, increased physical activity, DASH diet, smoking cessation
what cx can develop from nephritic syndrome?
HTN, heart failure, pulmonary edema, chronic kidney injury (may need renal transplant), neuro bc urea (azotemia) build up
AKI is more common in nephritic
