Nephritic and nephrotic syndromes

Nephritic and nephrotic syndromes

Nephritic syndrome
Haematuria (red or brown urine)
Oedema and generalised fluid retention
Hypertension
Oliguria

The complete form is classically seen in post-infectious glomerulonephritis, may occur in acute IgA nephropathy, and occasionally occurs in other types of glomerulonephritis. The presence of one or more features is common to many types of glomerular disease.

Nephrotic syndrome

Nephrotic syndrome refers to the secondary phenomena that occur when substantial amounts of protein are lost in the urine

Overt proteinuria: usually > 3.5 g/24 hrs (urine may be frothy)

Hypoalbuminaemia (< 30 g/L)
Oedema and generalised fluid retention
Intravascular volume depletion with hypotension, or expansion with hypertension, may occur


Classically seen in non-inflammatory and subacute inflammatory/proliferative glomerular disorders

Consequences of the nephrotic syndrome and their management

Hypoalbuminaemia
Urinary protein losses exceed synthetic capacity of liver leads to reduced oncotic pressure &oedema ( can be managed by diuretics and a low-sodium diet ).

Avid sodium retention

Secondary hyper-aldosteronism & additional poorly characterised intra-renal mechanisms lead to oedema .

Hypercholesterolaemia

Non-specific increase in lipoprotein synthesis by liver in response to low oncotic pressure with a consequence of high rate of atherosclerosis that can be managed by Lipid-lowering drugs (e.g. HMG CoA reductase inhibitors).

Hypercoagulability

Relative loss of inhibitors of coagulation (e.g. antithrombin III, protein C and S) and increase in liver synthesis of procoagulant factors lead to venous thromboembolism so we must consider prophylaxis in all patients with chronic or severe nephrotic syndrome.

Infection

Hypogammaglobulinaemia (urinary losses) leads to Pneumococcal infection( Consider vaccination).

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