Nephritic syndrome is a kidney disorder characterized by inflammation of the glomeruli—the tiny filtering units in the kidneys. This condition leads to the leakage of red blood cells and proteins into the urine, impaired kidney function, and fluid retention.
In adults, nephritic syndrome is often a sign of an underlying kidney disease or systemic illness. Prompt recognition and treatment are critical, as untreated nephritic syndrome can progress to chronic kidney disease or even kidney failure.
The kidneys contain about one million nephrons, each made up of a glomerulus (filtering capillaries) and a tubule (which processes filtered fluid).
Glomerulus: Removes waste and excess fluid while retaining proteins and blood cells.
Nephritic damage: Inflammation disrupts this selective filtration, allowing blood cells and proteins to leak into urine, while also reducing the glomerular filtration rate (GFR).
The result is a clinical picture of hematuria, proteinuria, hypertension, and varying degrees of kidney dysfunction—the hallmarks of nephritic syndrome.
Adult nephritic syndrome has multiple causes, which can be primary (kidney-limited) or secondary (systemic disease-related):
Primary Glomerular Diseases
Post-infectious glomerulonephritis – Following infections such as streptococcal throat or skin infections.
IgA nephropathy (Berger’s disease) – The most common cause worldwide, due to abnormal deposition of IgA in glomeruli.
Membranoproliferative glomerulonephritis (MPGN).
Secondary Causes
Systemic lupus erythematosus (SLE).
Vasculitis syndromes (e.g., ANCA-associated vasculitis, Goodpasture’s syndrome).
Infective endocarditis or chronic infections.
Hepatitis B or C infections.
Risk Factors
Recent infection (especially streptococcal).
Autoimmune disease history.
Exposure to certain medications or toxins.
Family history of kidney disease.
Nephritic syndrome can present suddenly or gradually. Typical symptoms include:
Hematuria (blood in urine): Often giving urine a smoky or cola-colored appearance.
Proteinuria: Usually mild to moderate, unlike the heavy protein loss in nephrotic syndrome.
Oliguria: Reduced urine output due to impaired filtration.
Edema: Swelling of the face, hands, feet, or ankles.
Hypertension: Elevated blood pressure caused by fluid and salt retention.
General symptoms: Fatigue, headache, loss of appetite, nausea.
Severe cases may present with acute kidney injury (AKI), seizures (due to high blood pressure), or shortness of breath from fluid overload.
A detailed evaluation is necessary to confirm nephritic syndrome and identify its cause:
Medical history & physical exam: Look for recent infections, autoimmune symptoms, or risk factors.
Laboratory tests:
Urinalysis: Shows hematuria, red blood cell casts, and proteinuria.
Blood tests: Elevated urea and creatinine (reduced kidney function), low complement levels in certain conditions.
Serological tests: ANA, ANCA, anti-GBM antibodies, hepatitis serologies.
Imaging: Kidney ultrasound to check size, shape, and exclude obstruction.
Kidney biopsy: Often required for a definitive diagnosis. Biopsy provides detailed information about the type and extent of glomerular inflammation, guiding treatment.
Management depends on the underlying cause, severity, and progression.
General Supportive Care
Blood pressure control: ACE inhibitors or ARBs are preferred.
Diuretics: To manage fluid overload and edema.
Salt and fluid restriction.
Dialysis: Required in cases of severe kidney failure or fluid overload unresponsive to medications.
Specific Treatments
Post-infectious GN: Supportive treatment, as it often resolves spontaneously.
IgA nephropathy / lupus nephritis / vasculitis:
Immunosuppressive therapy (corticosteroids, cyclophosphamide, mycophenolate mofetil).
Targeted biologics in certain cases (e.g., rituximab).
Goodpasture’s syndrome: Plasma exchange to remove harmful antibodies, combined with immunosuppressive therapy.
Infection-related causes: Antibiotics for underlying infection plus supportive kidney care.
While nephritic syndrome itself is not surgically treated, some procedural interventions may be needed:
Kidney biopsy:
Performed under local anesthesia with ultrasound guidance.
A needle is inserted into the kidney to obtain tissue samples.
Provides a clear diagnosis of the type of glomerulonephritis.
Plasma exchange (plasmapheresis):
Used in rapidly progressive or severe cases (e.g., Goodpasture’s syndrome).
Blood is circulated through a machine, plasma is removed and replaced with donor plasma or albumin to eliminate harmful antibodies.
For patients undergoing kidney biopsy or plasma exchange:
After kidney biopsy:
Bed rest for several hours.
Monitoring for bleeding or pain at the biopsy site.
Avoid heavy lifting for 1–2 weeks.
After plasma exchange:
Monitoring of blood pressure and electrolytes.
Supplementation with calcium (if citrate is used as anticoagulant).
Multiple sessions may be required.
Long-term rehabilitation focuses on controlling blood pressure, preserving kidney function, adhering to medications, and maintaining a healthy lifestyle.
Untreated or severe nephritic syndrome may lead to:
Acute kidney injury (AKI).
Chronic kidney disease (CKD).
End-stage renal disease (ESRD), requiring dialysis or transplantation.
Severe hypertension, leading to cardiovascular events.
Fluid overload, causing pulmonary edema.
Complications of treatment, such as infections (from immunosuppression) or bleeding (post-biopsy).
The outlook depends on the cause and severity:
Post-infectious GN: Often self-limiting, especially in young adults.
IgA nephropathy: Variable course, some patients progress to CKD.
Autoimmune/vasculitic causes: Require aggressive treatment but can achieve remission if diagnosed early.
Rapidly progressive GN: Poor prognosis without urgent treatment, but outcomes improve with immunosuppressive therapy and plasma exchange.
Early diagnosis and adherence to therapy significantly improve long-term kidney outcomes.
Seek medical attention if you experience:
Blood in urine (cola-colored or reddish urine).
Swelling of face, legs, or ankles.
Reduced urine output.
Persistent high blood pressure.
Unexplained fatigue, headache, or nausea.
Prompt medical evaluation can prevent long-term kidney damage.
Adult Nephritic Syndrome is a serious kidney condition caused by inflammation of the glomeruli, leading to blood and protein in urine, swelling, and impaired kidney function. It may result from infections, autoimmune diseases, or systemic disorders.
Diagnosis often requires a combination of blood tests, urine tests, and kidney biopsy. Treatment focuses on supportive measures, controlling blood pressure, and addressing the underlying cause with medications or plasma exchange.
Early recognition, regular follow-up, and timely intervention are crucial in preventing progression to kidney failure. If you notice blood in your urine, swelling, or signs of kidney dysfunction, consult a healthcare professional without delay.
Caring for every kidney, with expertise and compassion.
Trusted Nephrologist Doctor in Hyderabad.
