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Nephritic syndrome

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nephritic syndrome etiology pathophysiology clinical features

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nephritic syndrome diagnosis management treatment glomerulonephritis

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nephritic syndrome glomerulonephritis pathology

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Nephritic syndrome is a clinical syndrome caused by inflammatory injury of the glomeruli, classically presenting with:
  • Hematuria (often cola/tea-colored urine, RBC casts)
  • Hypertension
  • Azotemia (acute kidney injury pattern)
  • Oliguria
  • Mild to moderate proteinuria (usually less than nephrotic range)
  • Edema (often periorbital)
A classic morphologic correlate is proliferative GN with possible crescents on biopsy, as seen in pathology references on rapidly progressive GN ([webpathology image description]).
Renal biopsy showing crescentic glomerular injury, a severe nephritic pattern
Source: webpathology (image record on crescentic glomerular injury)

Common causes (by mechanism)

  1. Post-infectious / infection-related GN
  2. IgA nephropathy / IgA vasculitis
  3. Lupus nephritis
  4. ANCA-associated pauci-immune GN
  5. Anti-GBM disease (Goodpasture spectrum)
  6. Membranoproliferative/C3 glomerulopathy (complement-mediated)
KDIGO 2021 provides disease-specific diagnostic and treatment pathways across these glomerular disorders (KDIGO Glomerular Diseases Guideline update, Management of Glomerular Diseases, p. 27).

Diagnostic approach

  • Urinalysis + microscopy: dysmorphic RBCs, RBC casts, proteinuria
  • Renal function: creatinine, BUN, electrolytes
  • Serology guided by suspicion:
    • C3/C4
    • ASO/anti-DNase B (post-strep context)
    • ANA, anti-dsDNA (lupus)
    • ANCA
    • Anti-GBM antibodies
    • Hepatitis B/C, HIV when indicated
  • Kidney biopsy in most significant/rapidly progressive cases to define subtype and urgency of immunosuppression

Management principles

  • Supportive care for all:
    • Salt/fluid restriction
    • Loop diuretics for edema
    • BP control (often RAAS blockade when appropriate)
    • Treat triggers (eg, active infection)
  • Cause-specific immunotherapy when indicated:
    • High-dose steroids ± cyclophosphamide/rituximab for severe crescentic immune GN (depending on subtype)
    • Plasmapheresis in selected anti-GBM disease/severe pulmonary hemorrhage contexts
    • Lupus/ANCA/IgA regimens tailored to biopsy and severity
KDIGO emphasizes structured diagnosis, risk stratification, and subtype-specific therapy rather than one uniform regimen for all nephritic presentations (KDIGO 2021 guideline update, p. 27).

Nephritic vs nephrotic (quick contrast)

  • Nephritic: inflammatory, hematuria + HTN + AKI, less proteinuria
  • Nephrotic: heavy proteinuria, hypoalbuminemia, generalized edema, hyperlipidemia
If you want, I can give you a one-page exam-style table of nephritic causes with complement levels, IF patterns, and key serologies.
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