Nephritic syndrome

Nephritic syndrome is a complex of clinical and laboratory signs characterizing pathological changes in the kidneys in a number of primary and secondary nephropathies that lead to damage to vital organs. This condition of the body progresses due to infectious diseases, so it is often also called post-infectious glomerulonephritis. The inflammatory process affects the glomeruli of the kidneys, and fluid, metabolic products, salts are retained in the body, and severe hematuria and proteinuria are observed.

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Causes nephritic syndrome

The causes of nephritic syndrome can be various forms of nephritis (most often the streptococcal form), autoimmune diseases, and autoimmune reactions more common in everyday life (with tonsillitis, viral diseases, injuries to internal organs), etc.

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Risk factors

Factors causing nephritic syndrome can be divided into:

• Bacterial: pneumococcal infection, sepsis, endocarditis, typhoid fever;
• Poststreptococcal glomerulonephritis (glomerular nephritis);
• Other types of post-infectious glomerulonephritis (diffuse membranous, diffuse mesangial proliferative, diffuse endocapillary proliferative, diffuse mesangiocapillary, diffuse crescentic);
• Viral (hepatitis B, ECHO virus, etc.);
• Kidney diseases such as amyloidosis, mycoses, drug-induced nephropathy, interstitial nephritis;
• Autoimmune diseases (vasculitis, systemic lupus erythematosus, hereditary pulmonary-renal syndrome).

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Symptoms nephritic syndrome

The following are characteristic features that indicate nephritic syndrome:

• Hematuria (blood in the urine);
• Macrohematuria;
• Edema formation;
• Most people suffering from the syndrome have arterial hypertension;
• Development of hypocomplementemia (decreased hemolytic activity of complement and C3 levels);
• Oliguanuria (slow urine production) and a feeling of thirst.

There are also a large number of symptoms, having analyzed the totality of which, we can talk about nephritic syndrome:

• Morning headache;
• Dark foamy urine (usually in the morning);
• Lumbar pain (at night);
• Elevated temperature;
• Vomiting, nausea;
• Some respiratory diseases that are infectious in nature.

Nephritic syndrome in children

Nephritic syndrome in childhood is determined by a pediatrician based on a combination of laboratory and clinical signs. Small patients have various glomerular disorders, edema, arterial hypertension, developing against the background of previous diseases. This syndrome can be provoked by heavy physical exertion, stress, hypothermia.

The process of nephritic syndrome is less dangerous for a child's body than for an adult, since a child's body responds well to treatment with corticosteroids. But recovery also depends on many factors, such as the child's age, the cause of the disease, the treatment methods used, and the presence of various complications.

Forms

There are two forms of nephritic syndrome: acute and chronic.

Acute nephritic syndrome is observed in:

• Post-infectious glomerulonephritis;
• Acute secondary glomerulitis (small artery vasculitis, lupus nephritis, ABM nephritis);
• Malignant hypertension;
• Acute tubulointerstitial nephritis and glomerulitis (drug-induced and toxic);
• Acute gouty crisis;
• Acute transplant rejection reaction.

In all of the above cases, the development of acute renal failure (ARF) is possible.

Chronic nephritic syndrome is observed in:

• Various types of proliferative glomerulonephritis;
• Secondary glomerulopathies (Schonlein-Henoch, diabetes, lupus nephritis, alcohol, drugs);
• Chronic tubulointerstitial nephritis;
• Chronic immunopathy (AIDS, hepatitis, rheumatoid arthritis, Jagoodpasture's disease, etc.);
• Chronic transplant nephropathy.

In all of the above cases, the development of chronic kidney disease is possible.

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Complications and consequences

The consequence of the nephritic syndrome is its modification into a chronic form. The chronic form, in general, proceeds latent, is diagnosed late and has unclear general symptoms. Another complication of the consequences of the syndrome is the development of chronic renal failure.

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Diagnostics nephritic syndrome

Methods of diagnosing nephritic syndrome:

1. Clinical blood test.
2. Blood biochemistry:
   • Protein, lipid and water-electrolyte metabolism;
   • Calculation of the glomerular filtration rate of the kidneys using one of the formulas;
   • Search for markers of systemic diseases (antibodies to neutrophil cytoplasm, hepatitis markers, cryoglobulins, etc.)
3. Daily proteinuria.
4. Immunological blood test.
5. Instrumental diagnostics:
   • Radial hemolysis reaction;
   • Computed tomography;
   • Ultrasound examination;
   • Radiography;
   • Angiography;
   • In some cases - kidney biopsy.

To obtain the most accurate representation of the course of this syndrome, a number of additional studies are also carried out. Here is a list of some of them:

• Throat swab;
• Consultation with an infectious disease specialist;
• Bacterial urine culture;
• Schwartz filtration index;
• Examination of the patient's fundus;
• Chest X-ray;
• Blood pressure measurement;
• Consultation with an otolaryngologist.

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Differential diagnosis

In medicine, there is also the concept of nephrotic syndrome. The difference between nephrotic syndrome and nephritic syndrome is that nephritic syndrome indicates symptoms resembling signs of acute nephritis - inflammation of the kidney. And nephrosis is a whole complex of kidney damage, this is its main difference. Also, nephrotic syndrome is often inherited.

Nephritic syndrome, unlike nephrotic syndrome, occurs suddenly and indicates that the underlying disease is progressing. Therefore, there are visible differences between nephrotic and nephritic syndromes.

The main signs indicating the occurrence of nephritic and nephrotic syndromes are given in the table:

Nephritic: Trace proteinuria; Micro- and macrohematuria; Arterial hypertension; Azotemia;

Nephrotic: Soft tissue swelling; Polyserositis; Oliguria; Proteinuria; Lipiduria; Hypo- and dysproteinemia; Hypercholesterolemia.

Treatment nephritic syndrome

Treatment of nephritic syndrome involves treating the disease that caused the syndrome. Treatment of acute and chronic nephritic syndromes differs significantly. Thus, when treating acute nephritic syndrome, it is first necessary to:

1. Hospitalization in a specialized hospital;
2. Elimination of the etiological factor – antibiotics, restoration of hemodynamics, reduction of blood pressure, discontinuation of toxic drugs;
3. In the development of acute renal failure, dialysis therapy is necessary;
4. In case of very rapid progression, corticosteroid pulses and plasma exchange are required;
5. Diuretics are used to flush the tubules;
6. Use of anticoagulants and thrombolytics in thrombosis;
7. Prescription to observe bed rest, limit the amount of liquid, eliminate salt, limit the intake of various proteins into the body, increase the amount of vitamins.

When treating chronic nephritic syndrome it is necessary:

1. The primary goal is to treat the underlying disease;
2. Use of antibiotics, plasmapheresis – if necessary;
3. Reduction of high blood pressure;
4. Combating hypercholesterolemia;
5. Nonsteroidal anti-inflammatory drugs as indicated (with caution);
6. Improved microcirculation;
7. Limiting the availability of protein to the body;
8. Changes in the patient’s lifestyle – fatty foods, alcohol, smoking, etc.

Treatment of the underlying disease, namely glomerulonephritis, which is accompanied by nephritic syndrome, combines drug and non-drug treatment.

In children, when treating acute nephritic syndrome, emergency hospitalization is first and foremost required. Then follows a list of actions similar to those in the case of an adult patient: bringing the child out of the acute condition, eliminating azotemia, edema, convulsions, reducing proteinuria, hematuria, etc.

In the treatment of the chronic form of nephritic syndrome, planned hospitalization is carried out. The purpose of this stage is to adopt a number of procedures aimed at the final recovery of the child, eliminating the occurrence of a relapse.

In both cases (chronic and acute forms of nephritic syndrome), after the patient is discharged, adults must ensure that the child follows the regimen, diet, and undergoes periodic dispensary observation.

Non-drug treatment:

• Limiting the patient's intake of table salt;
• Limit the amount of liquid;
• Elimination of spicy foods, seasonings, spices, alcoholic beverages, strong tea, coffee, and canned foods from the diet.

Drug treatment:

Treatment is carried out under the obligatory condition that the source of infection is located in the body.

• In certain post-streptococcal acute glomerulonephritis, cephalexin is prescribed. Dosage: 50 mg per kilogram of body weight, 2 times a day, duration of administration is 10 days. Contraindications for taking this drug are children under three years of age and hypersensitivity to beta-lactam antibiotics.
• In cases of pneumonia and sinusitis, the following is prescribed: amoxicillin with clavulanic acid, 500-700 mg, 2 times a day, for 7 days. The drug is contraindicated for patients with bronchial asthma, liver failure, infectious mononucleosis, and during lactation.
• In case of allergy to beta-lactam antibiotics, macrolide drugs are prescribed: azithromycin 250-500 mg, 1 time per day, duration of administration is 4 days (contraindicated for children under 12 years of age, in case of liver failure, during lactation); spiramycin - 150 mg, also 2 times per day, duration of administration is 7 days (contraindicated for children and adolescents under 18 years of age, during lactation, in case of hypersensitivity to the drug).
• In case of severe edema, it is also possible to prescribe antiplatelet agents and anticoagulants, such as heparin (methods of administration of the drug and doses are individual in different cases), curantil (dosage from 75 to 225 mg, also individual).

It should be noted that the above drugs for the treatment of nephritic syndrome are one of many treatment options. In each identified case, the doctor prescribes treatment individually, it depends on the complexity of the medical history and the results of a comprehensive examination.

Surgical treatment: not necessary.

Treatment with folk remedies:

To treat nephritic syndrome, people use various herbs and herbal infusions, for example:

• Infusion of dried rose hips: pour boiling water over dried rose hips - 2 teaspoons per 300 milliliters - leave in a closed container and take 50 ml every 2 hours;
• Infusion of birch leaves (pour hot boiled water over the first fresh leaves at a rate of 100 grams per 2 glasses of water, leave for 4.5-5 hours) drink ½ glass several times a day;
• Infusion of herbal collection (calendula, St. John's wort and immortelle flowers - 40 grams each, chicory (flower) and buckthorn bark - 30 grams each, knotweed, chamomile - 20 grams each, 1 tbsp. Pour 250 milliliters of boiling water over the resulting mixture, leave for 35-45 minutes) drink ½ glass 2 times a day.
• Infusion of herbal collection (field horsetail, bearberry, dry birch leaf: 1 tbsp. of all ingredients, 600 ml of boiling water, leave for 30 minutes) drink 100 ml 3 times a day.

It is important to know that herbal infusions prepared for children should be less concentrated. The amount of dry ingredients is determined depending on age: children under 1 year - at the rate of ½ teaspoon of dry mixture per day, children from 1 to 3 years - 1 teaspoon, children from 3 to 6 years - 1 dessert spoon, children from 10 years - 2 tablespoons. In addition, it is necessary to take into account the possible intolerance of plant components for each patient with nephritic syndrome individually.

Use of vitamins:

One of the important components of a patient's rapid recovery is supporting his body with natural microelements and vitamins. To do this, the food of a person undergoing therapy for nephritic syndrome must be filled with "healthy" products. These are foods containing vitamin A (carrots, cabbage, lettuce), B vitamins (nuts, apples, oats, buckwheat, beets), vitamin C (sea buckthorn, black currant, rose hips), vitamin E (sweet bell peppers, olives, wheat germ oils), vitamin D (caviar, parsley, vegetable oils), etc.

Prevention

Prevention of nephritic syndrome is the prevention of diseases that can lead to the development of this syndrome. These are viral infections, bacterial infections, electrolyte imbalance, cardiovascular failure, etc. Also, in the event of the above-mentioned diseases, it is necessary to seek medical help, not to let the disease "take its course" and strictly follow the doctor's recommendations regarding the work and rest regime.

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Forecast

If proteinuria, hypercholesterolemia and high blood pressure persist, patients with nephritic syndrome may develop:

• Nephrosclerosis (a disease in which functional kidney cells die, as a result of which the kidney shrinks and does not perform its basic functions);
• Cardiovascular damage.

Fatal outcome in patients is very rare. And timely measures for the treatment of nephritic syndrome often give a favorable prognosis.

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