DR Medhat MRCP

Nephritic syndrome
Def :
Clinical syndrome associated with underlying glomerulonephritis
Features :
Causes :
Hematuria (usually microscopic).
Proteinuria.
Hypertension.
Oliguria ( low GFR) / generalized oedema (salt & water retention).
Acute or rapidly progressive renal impairment.
Nephritic urinary sediment (hematuria ,dysmorphic RBCs,RBCs & granular casts,
sub-nephrotic range proteinuria).
Diffuse proliferative
focal proliferative
1. Post streptococcal GN 1. IgA nephropathy
2. SLE 2. HSP
3. MPGN (malaria,hepatitis,HUS/TTP,chr infection) 3. Alport syndrome
4. RPGN (ANCA-associated GN, anti-GBM disease) 4. SLE
5. Cryoglobulinemia 5. Coeliac disease
6. Dermatitis herpitiformis
Mechanisms of glomerular injury :
1) Autoantibody/Antigen binding formation of
2) Complement fixation & activation immune complexes
3) Recruitment of inflammatory cells (neutrophils & macrophages)
4) Relase of cytokines ,proteases ,growth factors ,vasoactive factors ,oxidant species &
procoagulants) Damage to, and activation of, surrounding cells and matrix
haematuria, proteinuria, and impairment of glomerular filtration.
5) Cellular immunity may also contribute to structural glomerular damage — this is
especially true of pauci-immune GN (e.g. the GN associated with ANCA-positive
vasculitis) where ICs play no pathological role.
6) Resolution of inflammation might return an infl amed glomerulus to normal or, if the
healing phase is poorly regulated, may result in cellular dropout, scarring,
glomerulosclerosis, and CKD.
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