The document provides a detailed overview of nephritic syndrome and related glomerular diseases, including their causes, pathogenesis, and clinical features. It discusses conditions such as post-streptococcal glomerulonephritis, emphasizing the immune response and potential complications. Diagnosis and treatment options are reviewed, with a focus on supportive care and management of symptoms.

1. NEPHRITIC SYNDROME
Dr. Salman Ansari
Kanachur Institute of Medical Sciences

2. Contents
● Glomerular diseases
● Glomerulonephritis: causes + pathogenesis
● Acute Nephritic Syndrome
● Post streptococcal glomerulonephritis(PSGN)

3. Glomerular diseases
Glomerular diseases include:
- Acute nephritic syndrome
- Rapidly progressive glomerulonephritis
- Nephrotic syndrome
- Chronic nephritis
- Asymptomatic urinary abnormalities(hematuria,
proteinuria or both)

4. Glomerulonephritis
Definition: inflammation of glomeruli

5. Causes of glomerulonephritis
Primary GN Secondary GN(systemic)

6. Causes of glomerulonephritis
Primary GN Secondary GN(systemic)
● Acute proliferative GN
● Rapidly progressive(crescentic)
GN
● MCD
● FSGS
● Chronic GN

7. Causes of glomerulonephritis
Primary GN Secondary GN(systemic)
● Systemic Lupus Erythematosus
(SLE)
● Diabetes mellitus
● Vasculitis disorders
● amyloidosis

8. Causes of glomerulonephritis
Primary GN Secondary GN(systemic)
● Systemic Lupus Erythematosus
(SLE)
● Diabetes mellitus
● Vasculitis disorders
● amyloidosis
● Acute proliferative GN
● Rapidly progressive(crescentic)
GN
● MCD
● FSGS
● Chronic GN

9. 3rd category: hereditary disorders
- Alport syndrome
- Fabry disease
- Thin basement membrane disease

10. Pathogenesis
- It is immune complex-mediated
- Antigen attaches to antibody and forms antigen-antibody
complex(or immune complex)
- This circulates in blood and reaches the glomerulus of kidney
and causes inflammation
- In some cases, antibodies are produced against antigen of
basement membrane - this is called anti-GBM antibody-
induced glomerulonephritis

11. Acute Nephritic Syndrome
Syndrome consisting of:
- Oliguria
- Hematuria
- RBC casts in urine
- Hypertension
- Edema
- proteinuria(not severe)
- Azotemia(high blood urea nitrogen)
Post-streptococcal glomerulonephritis(PSGN) is a common cause of
nephritic syndrome

12. Etiology of PSGN
- Causative organism: group A streptococcus(GAS)
- Occurs few weeks after streptococcus infection of
pharynx(pharyngitis) or skin infection(impetigo)
- Immune complex-mediated - type III hypersensitivity reaction

13. Pathogenesis
Antibodies produced in response to streptococci
↓
Combine with antigen and form antigen-antibody complex
↓
Circulate in blood and get deposited within glomeruli of kidney
↓
Cause inflammation - “glomerulonephritis”

15. Clinical features
● Children between 6-10 years of age
● Malaise, fever, nausea, oliguria
● Classic triad
1. hematuria(smoky or cola-coloured urine)
2. Periorbital edema
3. hypertension
● Other: proteinuria(less than 3.5 g/day)
● In adults: sudden hypertension and elevation of BUN

18. PSGN
Hematuria
Edema
Hypertension

19. Diagnosis
● High Anti-Streptolysin O(ASO) titer
● Low serum complement(C3)
● RFT: Elevated urea and creatinine
● Urinalysis: hematuria, RBC casts, mild proteinuria ☆
● Renal biopsy: acute inflammation in glomerulus with neutrophils
and immunoglobulin deposits

20. Treatment:
● Supportive treatment - rest
● Salt restriction
● Diuretics for edema
● Antihypertensives to control high BP
● Dialysis is done in severe oliguria and hyperkalemia

21. Complications of PSGN
● Rapidly progressive glomerulonephritis
● Pulmonary edema
● Hypertensive encephalopathy
● Renal failure

25. Short answers
Hematuria: Presence of blood in urine
Causes of hematuria:
● Post-streptococcal glomerulonephritis
● Alport syndrome
● IgA nephropathy
● Trauma
● Renal cell carcinoma

26. Proteinuria: presence of protein in urine
Causes of proteinuria:
● Glomerulonephritis
● Diabetic nephropathy
● hypertension

27. Urine findings in glomerulonephritis:
- Oliguria
- Mild proteinuria
- Hematuria (smoky or cola-colored urine)
- Urine microscopy shows RBC casts

28. Questions:
LE:
SE: Acute nephritic syndrome or acute glomerulonephritis or post-
streptococcal GN = all 3 are same
SA:
- define hematuria
- 3 causes of hematuria
- urine findings in GN

29. For notes, click here
or scan:
References:
● Archith Boloor, Ramadas Nayak - Exam
Preparatory Manual
Questions:
salman.s.ansari92@gmail.com
For PPT, scan: