NEPHRITIC SYNDROME

NEPHRITIC SYNDROME

  • It is a syndrome comprising signs of nephritis, which is kidney disease involving inflammation. it often occurs in the glomerulus, which is called glomerulonephritis
  • Vasculitis - GFR decreased and renin increased leading to
- Hypertension
- Hematuria
- Sub nephrotic proteinuria


POST STREPTOCOCCAL GLOMERULONEPHRITIS (PSGN)
  • Type III Hypersensitivity reaction
  • Immunological manifestation seen with nephritogenic stain - streptococcus
  • Antigen - streptococcal pyrogenic exotoxin B (SPEP)
  • Immune complex (+) - complement mediated vasculitis
  • PSGN - begin as impetigo or pharyngitis


  1. Hematuria cola coloured urine - smoky urine(freshly voided sample)
  2. Hypertension - sudden onset - left ventricular failure
  3. Dyspnea - pulmonary edema
  4. Renal insufficiency leading to feature of uremia


WORKUP:

  • Urine microscopic - >3 RBC/HPF (high power field)
- RBC casts
- Dysmorphic RBC - always indicate glomerular bleeding
  • C3 decreased, CH50 decreased, C4 normal
  • Anti DNAase increased and Anti Hyaluronidase increased
  • Kidney biopsy - 
- light microscopy - hyper cellularity
- polymorpho nuclear cell infiltration
-IgG/IgM/C3 deposits (sub epithelial cell deposits)
  • Immuno florescence study - Starry sky appearance



TREATMENT

  • Acute pulmonary edema - furosemiide
  • HTN crisis - IV labetalol, ACEI
  • Hemodialysis

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