Nephritic Syndrome: Management and Complications
Nephritic syndrome is defined by the classic triad of hematuria (often “cola-colored”), hypertension, and oliguria/azotemia, resulting from glomerular inflammation.
1. Therapeutic Management
| Goal | Intervention |
|---|---|
| Blood Pressure | Loop diuretics (e.g., Furosemide) for volume overload; CCBs or ACE inhibitors for sustained HTN. |
| Fluid/Electrolytes | Fluid restriction; salt restriction; management of hyperkalemia if GFR is significantly reduced. |
| Etiology-Specific | Antibiotics (e.g., Penicillin for post-streptococcal); immunosuppressants (steroids/cyclophosphamide) for RPGN or Lupus nephritis. |
2. Complications
- Hypertensive Emergency: Severe hypertension can lead to encephalopathy, seizures, or heart failure.
- Acute Kidney Injury (AKI): Progression to rapid decline in GFR, potentially requiring urgent dialysis.
- Hyperkalemia: Secondary to renal failure, requiring urgent medical management.
- Pulmonary Edema: Due to salt and water retention.
3. High-Yield Clinical Pearls
- The “Cola” Sign: Hematuria in nephritic syndrome is often glomerular, characterized by dysmorphic RBCs and RBC casts on microscopy.
- PSGN Distinction: In Post-Streptococcal Glomerulonephritis (PSGN), low C3 levels are a hallmark finding that usually normalize within 6–8 weeks.
NEET PG Hint: Remember: The most sensitive indicator of renal function in a patient with acute nephritis is the serum creatinine level; however, in a fluid-overloaded state, the most critical immediate intervention is the management of volume overload. For more high-yield nephrology protocols and free medical questions, visit mymedschool.org.