Nephritic Syndrome

Nephritic Syndrome Overview:

Think I as in infection rather than O as in oedema.

Nephritic syndrome is characterised by thin basement membranes in the nephrons due to inflammation. This permits larger particles like proteins and blood into the urine. Causes can be due to either infection, thrombotic, or autoimmune conditions.

Early detection is key. Unfortuinatly it is asymptomatic iuntil significant damage has occured.


Aetiology:

+ In Children or Adolescents

  • IgA nephropathy
  • Post-streptococcal glomerulonephritis
  • Hemolytic uremic syndrome
  • Henoch–Schönlein purpura

+ In Adults

  • Goodpasture syndrome
  • SLE
  • Rapidly progressing glomerulonephritis
  • Infective endocarditis
  • Infectious process
  • damage to the glom from AB antigen reaction
    • makes holes in the endothilial cells anbd glom becomes damaged
      • haematuria
    • glom shuts down
      • low GFR due to inflammation
      • high BP
      • Granular casts
      • oedama (not as much as nephrotic)
 

Symptoms:

Hematuria

Proteinuria

Hypertension

Blurred vision

Azotemia

Oliguria

 

Diagnostic Considerations:

  • Test for kidney function every year for at risk demographics
  • Blood pressure
  • Renal function tests

Diagnostic Considerations For Nephritic And Nephrotic Syndromes

Reference Range Nephritic Syndrome Nephrotic Syndrome
Blood Pressure 120/80 Insert Insert
Serum urea 3.57-5.71 mmol/L insert insert
Serum Creatinine 60-110 µmol/L (Males)

45-90 µmol/L (Females)
Normal or High Normal or High
Serum Albumin insert Normal Low
eGFR >90 Insert Insert
Blood Urea Nitrogen (BUN) 1.79-8.93 mmol/L S.I insert insert
Serum Sodium 135-145 mmol/L Normal or High Normal
Serum Bicarbonate (CO2) 23-32 mmol/L insert insert
Serum Potassium 3.5-5.3 mmol/L High Low
Serum Chloride 97-107 mmol/L insert insert
Urine Albumin 32-45 g/L Very Low Insert
Urine Creatinine 0.5-1.2 mg/dL High Normal
Specific Urine Gravity Insert High Normal
Anion Gap Insert insert insert
pH Insert insert insert
Screenshot 2017-11-25 12.04.11.png
 

Therapeutic Aims:

1. Determine And Treat The Cause

  • Diet and Medication Review (NSAIDs, Lithium, Gold, Mercury, antineoplastics, Quinine)

2. Manage Co-morbidities

Especially cardiovascular and uremic complications.

3. Reduce Inflammatory Damage In The Nephrons

  • TNF-a and NF-kB Inhibitors (Curcuma longa)
  • Flavonoid-rich Herbs (Scutellaria baicalensis, Vitis vinifera)
  • Glucocorticomimetics (Bupleurum falcatum, Rehmannia glutinosa)

4. Reduce Immune Mediated Damage

  • Immunomodulators (Astragalus membranaceus, Echinaceae purpurea, Hemidesmus indicus)

5. Tonify Renal Structure & Function

  • Renal Trophorestoratives (Solidago virgaurea, Crataeva nurvala)

6. Reduce Oedema

  • Diuretics (Solidago virgaurea, Taraxicum officinale, Asparagus officinalis, Petroselinum crispum)

7. Reduce Dysuria

  • Urinary Demulcents (Eltrygia repens, Zea mays, Althaeaofficinalis)

8. Prevent & Treat Opportunistic Urinary Tract Infection

  • Urinary Antiseptics (Juniperus communis)
  • Prevent Bacterial Adhesion (Vaccinum macrocarpon)
 

Differential Diagnosis:

  • Nephrotic syndrome
 

Cautions:

Rule out diabetic nephropathy.

 

Herbs For Nephritic Syndrome:

 

Author:

Justin Cooke

The Sunlight Experiment

Updated: June 2018


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References:

  1. RCPA, 2015, Bicarbonate. Retrieved 27/3/17 from: http://www.rcpa.edu.au/Library/Practising-Pathology/RCPA-Manual/Items/Pathology-Tests/B/Bicarbonate
  2. Weatherby, D., & Ferguson, S. (2002). Blood Chemistry and CBC Analysis: Clinical Laboratory Testing from a Funtional Perspective. USA: Bear Mountain Publishing