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Acute Nephritic Syndrome

Epidemiology
Incidence

• Incidence of pauci-immune rapidly progressive glomerulonephritis is 4 per million patients per year¹
• No reliable information on incidence of other forms of acute nephritic syndrome

Risk Factors Alcoholism

Description
Acute nephritic syndrome is a term that covers kidney diseases of a variety of aetiologies, which lead to active glomerulonephritis. May be due to infection (mostly with group A ß-haemolytic streptococci), auto-immune disease (particularly systemic lupus erythematosus), drug-induced (gold, penicillamine), or idiopathic².

Presentation
Symptoms Variable: symptoms are generally non-specific and may be absent.

Signs

• Haematuria, often with dysmorphic RBCs
• Urine sediment containing RBC casts
• Proteinuria
• Peripheral oedema

Differential Diagnosis

• Acute interstitial nephritis
• Nephrotic syndrome
• Prerenal acute renal failure

Investigations

• Urinalysis
• 24-h urine
• Renal biopsy

Associated Diseases
Systemic lupus erythematosus

Management
Patients with known or suspected acute nephritic syndrome should generally be managed by a renal specialist.

Non-Drug Plasmapheresis

Drugs Acute nephritic syndrome due to auto-immune causes can be treated with steroids (iv methlprednisolone 0.5–1 g per day for 3 days, followed by daily oral prednisolone 1mg/kg per day) or cyclophosphamide (1–2 mg/kg per day)³. Otherwise, treatment is generally supportive rather than specific.

Surgical Renal transplantation.

Complications

• Acute renal failure
• Chronic renal failure

Prognosis
Prognosis is variable and depends on aetiology.

References Used

1. Hedger N, Stevens J, Drey N, et al; Incidence and outcome of pauci-immune rapidly progressive glomerulonephritis in Wessex, UK: a 10-year retrospective study.;Nephrol Dial Transplant 2000 Oct;15(10):1593-9.[abstract] Full text 
2. Couser WG; Glomerulonephritis.;Lancet 1999 May 1;353(9163):1509-15.[abstract]
3. Glomerulo-nephritis. Singapore: Ministry of Health; 2001 Practice guidelines from Singapore

Last issued 30 Aug 2006