Clinical Features of Acute Nephritic Syndrome

In this article, we will discuss the Clinical Features of Acute Nephritic Syndrome. So, let’s get started.

Clinical Features

  • Edema or puffiness of face in the early hours of the morning with or without edema feet. It is due to proteinuria, salt and water retention, hypertension and reduced GFR.
  • Oliguria: Urine output is less than 400 ml/day. It ia due to depressed GFR.
  • Subnephrotic proteinuria <3 g/day: It leads to edema, occurs due to leakage of proteins into Bowman’s capsule due to glomerular injury and subsequently into the urine. About 20% adults even may have nephrotic range of proteinuria.
  • Smoky or brown colored urine: Oliguria with smoky urine is a characteristic feature of acute nephritic syndrome. The changes in color of the urine is due to gross or microscopic hematuria. There may be pyuria due to leakage of degenerated WBCs in the urine.
  • Hypertension: The headache, giddiness, malaise and weakness in acute nephritic syndrome is associated with hypertension which is due to salt and water retention. Occassionally hypertension may be associated with mental features called hypertensive encephalopathy.
  • Systemic symptoms: Headache, nausea, malaise, anorexia, flank pain are reported in 50% cases.
  • Circulatory congestion or left heart failure: It occurs due to capillaritis, increased cardiac output, and shortened circulation time, complicated further by acute left heart failure (pulmonary edema) due to salt and water retention and hypertension, producing cough, breathlessness, end-respiratory crackles and rales. Hemoptysis may occur.
  • Associated features: In classical post-streptococcal glomerulonephritis causing acute nephritic syndrome, the patient is usually a child, will have history of sore throat 1-3 weeks prior to the onset of syndrome. Streptococcal tonsillitis or pharyngitis, otitis media or cellulitis may be responsible. The latent period of 1-3 weeks is for formation of immune complexes and their deposition into glomeruli. The features of underlying cause or systemic illness or causative agent may be present at the time of acute nephritic syndrome.
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