Nephritic Syndrome for medical students.

1. Renal Pathology
for medical students
The Nephritic Syndrome
Professor Wadie M Y Elmadhoun, MBBS, MSc.,MD
E-mail: wadie2222@yahoo.com
Kidney Pathology – Nephritic Syndrome – Prof. Wadie 1

2. Presentation outlines
1. Intended Learning outcomes (ILOs).
2. The nephritic syndrome: definition, causes,
and clinical course.
3. Post-streptococcal glomerulonephritis.
4. IgA nephropathy.
5. Hereditary glomerulonephritis.
5. Quizzes.
6. Further learning resources.
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3. Intended Learning outcomes (ILOs)
• By the end of this session, the learner should be
able to:
1. Define the nephritic syndrome and explain its
components, causes and pathogenesis.
2. Describe and explain the post-streptococcal
glomerulonephritis.
3. Describe and explain IgA nephropathy.
4. Describe hereditary glomerulonephritis.
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4. Definition of the nephritic syndrome
• A clinical manifestation of glomerular disease,
characterized by
• Hematuria,
• Oliguria,
• Azotemia and
• Hypertension
• With/without proteinuria and edema.
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5. Overview of causes and pathogenesis
• The causes of the Nephritic Syndrome are
either:
1. Primary glomerular diseases (GN) or
2. Systemic diseases e.g. SLE.
• The main point in pathogenesis is:
• Proliferation of the cells within the glomeruli,
accompanied by leukocyte infiltration causing
capillary injury that leads to escape of red cells
(RBCs) into the urine and decreased glomerular
filtration rate (GFR).
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6. Nephritic Syndrome (NS)
• Hematuria: dysmorphic RBCs or RBCs casts in urine,
• Oliguria: decreased urine volume, less than 400
ml/day.
• Azotemia : elevation of creatinine and blood urea nitrogen
(BUN).
• Hypertension: elevated blood pressure(BP) in relation to
age.
• Proteinuria and Edema: less severe than that seen in nephrotic
syndrome.
Kidney Pathology – Nephritic Syndrome – Prof. Wadie

7. Two urine samples showing gross and microscopic
hematuria: in Nephritic Syndrome
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8. The nephritic syndrome: pathogenesis/etiology, pathological and clinical manifestations
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Immune complex deposition SLE, HIV, HBV, HCV, …
Leak of RBCs in urine
HematuriaHigh blood pressure & Azotemia
Inflammation
(Glomerunephritis)
Proliferation of cells
capillary Damage
Alteration in GFR

9. Abundant inflammatory cells and
cellular proliferation in glomeruli
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10. Post-streptococcal glomerulonephritis
• Is due to Ag-Ab complex deposition.
• The antigens may be endogenous or exogenous.
• Acute nephritis may follow many infections
including:
• Streptococci, pneumococci, staphylococci,
mumps, measles, chickenpox, HBV, HCV.
• Nephritis develops 1-4 weeks following infection.
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11. Kidney Pathology – Nephritic Syndrome – Prof. Wadie 11

12. Post-streptococcal glomerulonephritis
• There is deposition of C3 and IgG: subepithelial,
intramembranous and subendothelial.
• The onset of nephritis is abrupt: oliguria,
hypertension and azotemia is preceded by
general symptoms.
• There is hypocomplementemia and
• High anti-streptolysin-O (ASO) antibodies level
• More than 90% of children fully recover.
• 15%-50% of adults develop chronic kidney
disease over many years.
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13. 13

15. IgA Nephropathy
(Berger Disease)
• A disease of young age groups.
• Occurs within 1-2 days of a nonspecific
sore throat.
• It is one of the most common causes of
hematuria.
• There is abnormal production of IgA, that
deposits in the mesangium.
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16. IgA Nephropathy
(Berger Disease)
• Mild hematuria
• Mild proteinuria
• IgA deposits in mesangium

17. IgA Nephropathy: clinical coarse
• About 40% of patients have only
recurrent microscopic hematuria, with
or without proteinuria.
• About 10% develop acute nephritic
syndrome.
• 25% to 50% progress to chronic renal
failure within 20 years.
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18. Kidney Pathology – Nephritic Syndrome – Prof. Wadie
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19. Hereditary nephritis
• A group of hereditary glomerular diseases
caused by mutations in GBM proteins,
specifically type IV collagen.
• An example is Alport syndrome: nephritis,
nerve deafness and eye disorders.
• Most often as an X-linked disease, (affects
males).
• Patients may develop renal failure many years
later.
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20. ASSIGNMENT
• Can you write a brief note about each of the
following topics:
1. Define the nephritic syndrome and explain its
components, causes and pathogenesis.
2. Describe and explain the post-streptococcal
glomerulonephritis.
3. Describe and explain IgA nephropathy.
4. Describe hereditary glomerulonephritis.
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21. Quiz 1
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• Define the following terms:
1. Hematuria
2. Azotemia
3. High blood pressure (in adults)
4. Hypocompelemetemia.

22. Quiz 2
• List 5 differences between the nephrotic
syndrome and nephritic syndrome?
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23. Quiz 3
• The definition of nephritic syndrome includes:
A. Hyperlipidemia
B. Hematuria
C. 24 hour urine protein more than 40 grams.
D. Hypotension
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24. Quiz 4
• A patient exhibits blood pressure 180/100
mmHg, urine volume of 250 ml/24 hr, urine
examination shows 40-60 dysmorphic RBCs
under microscope. What will glomerular
biopsy show?
• Answer:
• Proliferation of endothelial and mesangial
cells with heavy leukocyte infiltration.
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25. Quiz 5
• Name 3 disorders that present
as nephritic syndrome.
• Answer:
1. Post-streptococcal GN
2. IgA Nephropathy
3. Alport syndrome.
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26. Further sites for learning
1. https://unckidneycenter.org/kidneyhealthlibrary/glomerul
ar-disease/post-infectious-glomerulonephritis-gn/
2. https://www.pathologyoutlines.com/topic/kidneypoststre
p.html
3. https://glomcon.org/overview-of-gn/basic-principles-of-
renal-pathology-part-1/
4. https://www.kidneypathology.com/English_version/Tutori
al_index.html
5. https://en.wikipedia.org/wiki/Kidney
6. https://en.wikipedia.org/wiki/Glomerulonephritis
7. http://www.pathwaymedicine.org/basic-glomerular-
pathogenesis
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27. More renal pathology topics and
illustrations
• https://webpath.med.utah.edu/RENAHTML/R
ENALIDX.html#9
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28. Thanks
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