Nephritis (Nephritides)

Hunter enlarged kidney[1]

Nephritis is a condition, characterized by inflammation of the kidneys, which is majorly caused by infections, autoimmune diseases or exposure to toxins. The kidneys constitute of the glomerulus, interstitial tissue and tubules.

Presentation

Some of the common symptoms of nephritis include the following [6]:

  • Feeling of pain and burning sensation during urination
  • Presence of blood and pus in the urine
  • Fever accompanied by vomiting 
  • High blood pressure in individuals who have developed glomerulonephritis
  • Pain in the pelvic region, kidneys and or abdomen
  • Development of edema in the face, legs and hands due to accumulation of fluid
  • Frequency in urge to urinate
  • Urine is cloudy in appearance 

Skin
Erythema
  • Physical examination was remarkable for malar erythema, tender joints and an elevated blood pressure.[consultqd.clevelandclinic.org]
  • Rule Sensitivity Specificity Misclassified cases(number) 1997 ACR criteria 267/310 (86%) 365/392 (93%) 70 SLICC criteria 292/310 (94%) 361/392 (92%) 49 11. 1997 ACR criteria Malar rash Fixed erythema, flat or raised, over the malar eminences Discoid rash[slideshare.net]
  • more...
  • urogenital
    Renal Injury
    • The latter type of renal injury is caused by hepatitis B virus (HBV), hepatitis C virus (HCV), a part of HIV and parvovirus B19.[omicsonline.org]
    • In secondary care Investigations are focused on assessing severity of renal injury and looking for the underlying cause - discussed in detail in the separate Glomerulonephritis article.[patient.info]
    • Acute interstitial nephritis (AIN) defines a pattern of renal injury usually associated with an abrupt deterioration in renal function characterized histopathologically by inflammation and edema of the renal interstitium.[aafp.org]
    • This would be expected to halt or decrease immune complex production and thus ongoing immune complex–mediated renal injury.[cjasn.asnjournals.org]
    Uremia
    • It is manifested by polyuria, urine of low specific gravity, and terminal uremia. lupus nephritis glomerulonephritis associated with systemic lupus erythematosus. parenchymatous nephritis nephritis affecting the parenchyma of the kidney. suppurative nephritis[medical-dictionary.thefreedictionary.com]
    • Death is usually the result of uremia, dropsy, cardiac dilatation, or other complications.[henriettes-herb.com]
    • Do not neglect the occurrence of early Uremia symptoms like headache, loss of appetite, nausea and vomiting, decreased urination, etc.[kidneyabc.com]
    • […] such as primary vasculitis; myelitis; peripheral or cranial neuropathy in the absence of other known causes such as primary vasculitis, infection and diabetes mellitus; acute confusional state in the absence of other causes, including toxic-metabolic, uremia[slideshare.net]
    • Progressive renal failure leads to anemia, uremia, and electrolyte and acid-based abnormalities.[emedicine.medscape.com]
    Oliguria
    • Fractional Excretion of Sodium (FENa) may be useful if oliguria 7.[renalandurologynews.com]
    • Patients may be oliguric or nonoliguric; in a retrospective study that included 60 cases of AIN (92 percent of which were drug induced, with the remainder idiopathic), oliguria was present among 51 percent [ 11 ].[uptodate.com]
    • Clinical Features Patients with AIN typically present with nonspecific symptoms of acute renal failure, including oliguria, malaise, anorexia, or nausea and vomiting, with acute or subacute onset. 5 The clinical presentation can range from asymptomatic[aafp.org]
    Macroscopic Hematuria
    • A particular example is CKD observed after repeated episodes of isolated macroscopic hematuria ( 87 , 88 ).[cjasn.asnjournals.org]
    • Poor prognosis associated with hypertension, greater than 1.5 grams of protein/day, renal insufficiency or absence of macroscopic hematuria.[clinicaladvisor.com]
    • Features % Proteinuria 100 Miroscopic hematuria 80 Tubular abnormalities 60-80 Reduced renal function 40-80 Nephrotic syndrome 45-65 Granular casts 30 Rapidly declining renal function 30 Hypertension 15-50 Hyperkalemia 15 Macroscopic hematuria 1-2 Acute[slideshare.net]
  • more...
  • Eyes
    Periorbital Edema
    • […] symptoms related to hypertension and poor renal function (typical of diffuse lupus nephritis): Peripheral edema Headache and dizziness Nausea and vomiting Nephrotic symptoms related to proteinuria (ypical of membranous lupus nephritis): Peripheral or periorbital[emedicine.medscape.com]
  • more...
  • cardiovascular
    Hypertension
  • more...
  • gastrointestinal
  • more...
  • neurologic
    Stroke
    • Photo Credit Hilary Swift for The New York Times A Heart Risk Factor Even Doctors Know Little About Up to one in five Americans have high levels of lipoprotein(a) in their blood, putting them at risk of heart attacks and strokes.[nytimes.com]
    • Complications Primary complications associated with hypertension include: Seizure Encephalopathy Stroke End-organ damage Posterior reversible encephalopathy syndrome [ 4 , 5] Primary complications associated with kidney failure include: Fluid overload[emedicine.medscape.com]
    • Both lupus itself and the drugs taken to manage the disease can put the patient at greater risk of infection, cardiovascular disease, risk of stroke, osteoporosis, and weight gain.[hss.edu]
    • Manifestation Prevalence, % Neurologic 60 Cognitive disorder 50 Mood disorder 40 Headache 25 Seizures 20 Mono-, polyneuropathy 15 Stroke, TIA 10 Acute confusional state or movement disorder 2–5 Aseptic meningitis, myelopathy 9.[slideshare.net]
  • more...
  • Face, Head & Neck
  • more...
  • Entire body system
  • more...
  • Workup

    Various tests would be required for diagnosing the condition of nephritis. These would include the following [7]:

    • Laboratory studies: Several laboratory investigations would be required such as blood urea nitrogen levels, urine culture along with urinalysis and complete blood count. Blood tests to analyze levels of electrolyte and creatinine would be done. In addition to these, other laboratory studies include lupus serologies, antiDNAase B, serum IgA measurement, measurement of components C3 and C4, antistreptolysin and cellular antineutrophil cytoplasmic antibody. These tests would help detect infection in general and also give insights about presence of a bacterial infection [8] [9].
    • Biopsy: Biopsy of the kidney would be required when the patient shows signs of edema, proteinuria, hypertension and hematuria.
    • Imaging: Imaging studies such as CT scan of the abdomen and pelvic region is indicated to check for signs of infection. In addition to this, renal ultrasonography is done to rule out other conditions of tumor, kidney stones, renal artery stenosis and hematuria.

    Laboratory

    Serum
  • more...
  • Treatment

    The primary goal of treatment would be to correct the underlying disease condition that is causing nephritis. For this, medications and certain home care measurement would be required to treat the condition. Medications such as antibiotics are required if bacterial infections are the source of the problem. If autoimmune reactions are the cause, then various immunosupressants would be administered.

    Individuals with nephritis should give special considerations to their diet and their activity profile. Sodium and fluid restriction would be required if the patient is suffering from hypertension as the underlying condition. Along with this, a high carbohydrate diet would also be recommended for a short period in order to prevent breakdown of body protein. Calcium supplementation would also be indicated to maintain the normal serum calcium levels [10]. Individuals are also advised against carrying out strenuous activity; however, they are permitted to undertake daily light activities.

    Prognosis

    Prognosis of the condition is favorable with prompt initiation of treatment. However, failure to do so can cause damage to the organs, causing kidney failure. In such cases, individuals may require dialysis for filtering off the wastes from the body. Mortality due to nephritis in children is found to be higher in cases when there is development of complications. The several complications involved with kidney failure include uremia, anemia, overload of fluids, electrolyte imbalance, anorexia, sexual dysfunction and poor growth [5].

    Complications

    Ascites
    • The acetate and the citrate are valuable mild diuretics in Bright's disease and in feverish conditions, and by increasing the amount of urine diminish the pathological fluids in pleuritic effusion, ascites, &c.[yourdictionary.com]
    • Nephrotic syndrome may lead to edema, ascites, and hyperlipidemia, adding to the risk of coronary artery disease and the potential for thrombosis.[emedicine.medscape.com]
    Hemoglobinuria
    • Eculizumab has been shown to be very efficacious in preventing acute episodes of paroxysmal nocturnal hemoglobinuria and atypical hemolytic uremic syndrome, two diseases resulting from defective inhibition of the complement system at different levels[cjasn.asnjournals.org]
    Stroke
    • Photo Credit Hilary Swift for The New York Times A Heart Risk Factor Even Doctors Know Little About Up to one in five Americans have high levels of lipoprotein(a) in their blood, putting them at risk of heart attacks and strokes.[nytimes.com]
    • Complications Primary complications associated with hypertension include: Seizure Encephalopathy Stroke End-organ damage Posterior reversible encephalopathy syndrome [ 4 , 5] Primary complications associated with kidney failure include: Fluid overload[emedicine.medscape.com]
    • Both lupus itself and the drugs taken to manage the disease can put the patient at greater risk of infection, cardiovascular disease, risk of stroke, osteoporosis, and weight gain.[hss.edu]
    • Manifestation Prevalence, % Neurologic 60 Cognitive disorder 50 Mood disorder 40 Headache 25 Seizures 20 Mono-, polyneuropathy 15 Stroke, TIA 10 Acute confusional state or movement disorder 2–5 Aseptic meningitis, myelopathy 9.[slideshare.net]
    Goodpasture Syndrome
    • Immunologic diseases (eg, associated with lupus, Goodpasture syndrome) Acute transplant rejection Infections, including bacterial (must be accompanied by obstruction or reflux), viral (eg, cytomegalovirus [CMV], hantavirus, human immunodeficiency virus[emedicine.medscape.com]
    • It can also be caused by lupus and less common conditions such as Goodpasture syndrome or granulomatosis with polyangiitis (GPA).[medicalnewstoday.com]
    • ( N28.9 ) tubulo-interstitial nephritis NOS ( N12 ) Disease, diseased - see also Syndrome antiglomerular basement membrane (anti- GBM) M31.0 ICD-10-CM Diagnosis Code M31.0 Hypersensitivity angiitis 2016 2017 2018 Billable/Specific Code Applicable To Goodpasture's[icd10data.com]
    Mood Disorder
    • Manifestation Prevalence, % Neurologic 60 Cognitive disorder 50 Mood disorder 40 Headache 25 Seizures 20 Mono-, polyneuropathy 15 Stroke, TIA 10 Acute confusional state or movement disorder 2–5 Aseptic meningitis, myelopathy 9.[slideshare.net]
    Acute Interstitial Nephritis
    • Acute interstitial nephritis (AIN) is rapidly developing inflammation that occurs within the interstitium.[healthcommunities.com]
    • Treatment of Interstitial Nephritis Acute Interstitial Nephritis Withdrawal of the offending agent is the primary treatment for acute interstitial nephritis.[lecturio.com]
    • Drug-induced acute interstitial nephritis.[bestpractice.bmj.com]
    • This image shows acute interstitial nephritis.[emedicine.medscape.com]
    Proteinuria
    • […] for LN and may be an additional argument for a renal biopsy Proteinuria: – Most: isolated proteinuria 0.5 g/24 h – ACR: isolated proteinuria 1.0 g/24 h or 0.5 g/24 h and haematuria (5 RBCs/HPF) or cellular casts Active sediment: sufficient to warrant[ndt.oxfordjournals.org]
    • As explained in table 3 , we defined early CR, partial response (PR) and no response (NR) using three different sets of criteria, based on assessment of (1) proteinuria alone; (2) proteinuria and serum creatinine; and (3) proteinuria, serum creatinine[ard.bmj.com]
    • Fewer than 5% have nephrotic range proteinuria.[clinicaladvisor.com]
    • Proteinuria: UPC ratio 3.[arthritis-research.biomedcentral.com]
    • ACE inhibitors may be added at any level of proteinuria and may be used alone in the case of persisting proteinuria with a high chronicity index at biopsy.[cjasn.asnjournals.org]
    Autoimmune Disease
    • “The immodulatory potential of MSCs, along with their low immunogenicity, seems to offer a promising treatment for severe refractory autoimmune diseases,” concluded Dr.[lupusnewstoday.com]
    • Systemic lupus erythematosus (SLE) is an autoimmune disease found to play a role in lupus kidney disease and inflammation of the kidney.[belmarrahealth.com]
    • Lupus is an autoimmune disease.[kidneyfund.org]
    • Lupus is an autoimmune disease in which your immune system produces proteins called autoantibodies that attack your own tissues and organs.[mayoclinic.org]
    • Phase Cyclophosphamide in Lupus Nephritis The autoimmune disease systemic lupus erythematosus (SLE) commonly affects the kidneys (lupus nephritis) and for some patients leads to a progressive loss of kidney function.[centerwatch.com]
    Hypertension

    Etiology

    Autoimmune diseases are the major cause of nephritis. Following this, the condition can also occur due to infections and exposure to toxins. Individuals suffering from systemic lupus erythematosus are at an increased risk of developing nephritis. There have been instances, where nephritis can also be caused by heredity. However, such cases are rare and nephritis is majorly caused either by infections or autoimmune diseases. A kind of nephritis, known as athletic nephritis occurs as a result of excessive strenuous exercises. Such a type of condition gives rise to cylindruria, proteinuria and hematuria [2].

    Causes

    Hypertension

    Epidemiology

    The exact incidence of nephritis across the globe is unknown. Based on the statistics given by Center for Disease Control and Prevention, it was reported that approximately 39,480 people die due to nephritis in US each year. In addition, kidney disease was ranked 9th as the leading cause of mortality amongst the US population [3].

    Sex distribution
    Age distribution

    Pathophysiology

    Kidneys form an important organ of the body, responsible for maintain water and electrolyte balance, regulate acid-base concentration, and filtering off metabolic wastes. These bean-shaped organs process about 200 quarts of blood everyday and remove excess water and waste products from the body. Conditions interfering with the normal functioning of the kidneys are infections and underlying disease conditions.

    These factors promote development of inflammation of the organ which can further lead to kidney damage. In addition to infection and disease conditions, individuals can also develop nephritis if they have undergone surgical procedures of the kidneys or are allergic to certain medications [4].

    Prevention

    Certain practices can help prevent the onset of infections which would in a way avoid the onset of nephritis. Healthy living and appropriate water consumption can help keep the bladder clean and also avoid infections. Alcohol consumption and smoking are known to cause damage to the kidney and should therefore be avoided. Certain fruits and vegetables act as natural diuretics and should be made a part of daily diet. These consist of grapes and coconut water.

    Summary

    There are three types of nephritis, interstitial nephritis, glomerulonephritis and pyelonephritis. In interstitial nephritis, the area between the renal tubules undergoes inflammation. In the condition of glomerulonephritis, the filtering units of the kidneys, the glomeruli, get inflamed. Pyelonephritis occurs as a result of infection of the bladder, favoring development of inflammation of the kidneys. Nephritis, if not treated on time can turn severe, leading to development of several complications such as kidney damage [1].

    Patient Information

    • Definition: Nephritis is a condition, wherein the kidneys undergo inflammation usually either due to infections or autoimmune diseases. Such a type of condition should be promptly treated in order to avoid development of kidney damage.
    • Cause: The various causative factors for nephritis include bacterial infections, autoimmune diseases, and allergic reactions to antibiotics and or surgical procedures of the kidney. All these factors can trigger an inflammatory response, giving rise to nephritis.
    • Symptoms: Individuals with nephritis suffer from pain during urination, frequency in urge to urinate, pain in the abdomen and pelvic region, fever as well as vomiting. Affected individuals also experienced swelling in the arms and legs due to accumulation of fluids and also pass out blood in urine.
    • Diagnosis: The various diagnostic procedures employed include blood tests, blood culture, urinalysis, urine culture, complete blood count and serology tests. In addition, kidney biopsy would be required in individuals who suffer from hematuria, edema, proteinuria and hypertension.
    • Treatment: Antibiotic medications form the basis of treatment regime. Dietary restrictions along with fluid control would also be done in order to correct the condition of nephritis.

    Other symptoms

    No Hypertension
    No Hematuria
    • , pyuria, proteinuria and eosinophiluria, though may be bland Hematuria: present in 90% of cases Macroscopic (Gross) hematuria is classically seen with Methicillin (70% cases) Microscopic hematuria is seen in 90% cases of Methicillin related and 60% Non-Methicillin[renalandurologynews.com]
    • Patients may present with rash and hematuria.[emedicine.medscape.com]
    • This causes kidney inflammation and may lead to blood in the urine (hematuria), protein in the urine (proteinuria), high blood pressure, impaired kidney function or even kidney failure.[mayoclinic.org]
    • […] with microscopic hematuria and mild proteinuria.[clinicaladvisor.com]
    • A particular example is CKD observed after repeated episodes of isolated macroscopic hematuria ( 87 , 88 ).[cjasn.asnjournals.org]
    Hydroxychloroquine
    • The Canadian Hydroxychloroquine Study Group.[uspharmacist.com]
    • She was treated with potassium citrate and hydroxychloroquine 400 mg/day.[bmcmusculoskeletdisord.biomedcentral.com]
    • We continued the MMF and warfarin, reduced the prednisone to 20 mg daily and prescribed additional medications: Betamethasone lotion (for scalp lesions) Hydroxychloroquine (for rash, antiphospholipid syndrome and SLE) Lisinopril (for hypertension and[consultqd.clevelandclinic.org]
    • Hydroxychloroquine (Plaquenil) – This is a common medication for treating SLE .[mollysfund.org]
    • Videos Patient FAQs Treatments Abatacept (Orencia) Anakinra (Kineret) Apremilast (Otezla) Azathioprine (Imuran) Bisphosphonate Therapy Clinical Research Trials Cyclophosphamide (Cytoxan) Cyclosporine (Neoral, Sandimmune, Gengraf) Denosumab (Prolia) Hydroxychloroquine[rheumatology.org]
    Mild Proteinuria
    • […] abnormality; no abnormalities identified by H&E, immunofluorescence or EM; asymptomatic; may not actually represent renal disease II (10 - 20% of cases): pure mesangial lesions; mesangial expansion but mostly patent capillaries; mesangial immune deposits; mild[pathologyoutlines.com]
    • Nephritic syndrome is characterized by red blood cells and casts on urine microscopy, hypertension, renal insufficiency, mild proteinuria and edema.[clinicaladvisor.com]
    • […] associated with lead exposure, hypertension, gout, and proteinuria Sarcoidosis and AIN Granulomatous interstitial nephritis associated with hypercalcemia and pulmonary involvement Chronic interstitial nephritis Heavy metal exposure or other causes; mild[aafp.org]
    • Most of the cases presented with minimally symptomatic elevation of creatinine with mild proteinuria 6–12 weeks after initiation of ipilimumab.[ckj.oxfordjournals.org]
    • In the case of minimal renal symptoms such as microhematuria, short duration macroscopic hematuria, or mild proteinuria, one may choose not to start treatment because of the low CKD risk ( 14 ).[cjasn.asnjournals.org]
    Glomerulonephritis Autoimmune
    • See full list of 8 Types of Nephritis Causes of Nephritis Kidney conditions Glomerulonephritis Autoimmune nephritis Lupus nephritis Nephropathy more causes...»[rightdiagnosis.com]
    • Given below are some of the most common nephritis types: Acute nephritis Chronic nephritis Glomerulonephritis Primary glomerulonephritis Autoimmune nephritis Lupus nephritis Pyelonephritis Interstitial nephritis Though any of these types of nephritis[home-remedies-for-you.com]
    • These the common types of nephritis of the kidneys can affect people include: Acute nephritis Chronic nephritis Glomerulonephritis Primary glomerulonephritis Autoimmune nephritis Lupus nephritis Pyelonephritis Interstitial nephritis The factors that lead[diethealthclub.com]
    Severe Hypertension
    • Typically presents with gross hematuria, nephrotic or subnephrotic proteinuria, edema and severe hypertension.[clinicaladvisor.com]
    • A child with glomerulonephritis (GN) might die of potential complications of severe hypertension (eg, cerebral hemorrhage) or complications of renal failure (eg, hyperkalemia ).[emedicine.medscape.com]
    • There may be acute renal failure with severe hypertension in 20% of patients.[kidneypathology.com]
    Severe Proteinuria
    • […] rapidly progresses to renal failure without treatment V (10 - 15%): membranous glomerulonephritis; diffuse thickening of capillary walls, subepithelial and mesangial immune deposits (“spike and dome” pattern with silver stain); nephrotic syndrome or severe[pathologyoutlines.com]
    • Conditions associated with poor outcomes include preexisting hypertension, severe proteinuria in the first trimester, primary focal and segmental hyalinosis and sclerosis.[clinicaladvisor.com]
    • Failure to reach a creatinine clearance of 70 ml/min per 1.73 m 2 at 3 years and increasing proteinuria levels during follow-up correlate better with the risk of progression to CKD than decreased renal function, severe proteinuria, hypertension, or crescents[cjasn.asnjournals.org]
    Low Protein Diet
    • Effective use of a low protein diet is indicated by reduction in BUN, stable body weight, and stable serum albumin concentration on serial measurements.[vetbook.org]
    • Unfortunately, serious instruction about the value of a low protein diet is an important part of essential education that is missing from the medical care given most patients who have lost part of their kidney function.[drmcdougall.com]
    Organ Transplantation
    • Additional immunosuppressive drugs related to cancer and drugs used to prevent rejection of organ transplants may also be used.[kidneyurology.org]
    • Cyclosporine- and tacrolimus-induced nephropathy Although indispensable in the management of solid organ transplantation, cyclosporine and tacrolimus can cause acute and chronic nephrotoxicity.[emedicine.medscape.com]
    Renal Tubular Dysfunction
    Essential Hypertension
    • Case report Clinical history and initial laboratory data A 75-year-old Caucasian male with essential hypertension and recurrent metastatic melanoma presented with systemic morbilliform rash and AKI.[ckj.oxfordjournals.org]

    Self-assessment

    Ask Question


    5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.

    References

    1. Michel DM, Kelly CJ. Acute interstitial nephritis. J Am Soc Nephrol 1998; 9:506.
    2. Cornell LD. IgG4-related kidney disease. Curr Opin Nephrol Hypertens 2012; 21:279.
    3. Buysen JG, Houthoff HJ, Krediet RT, Arisz L. Acute interstitial nephritis: a clinical and morphological study in 27 patients. Nephrol Dial Transplant 1990; 5:94.
    4. Rossert J. Drug-induced acute interstitial nephritis. Kidney Int 2001; 60:804.
    5. Paueksakon P, Revelo M, Lee SM, et al. Acute renal failure in a 64-year-old white man.Am J Kidney Dis 2000; 36:669.
    6. Goda C, Kotake S, Ichiishi A, et al. Clinical features in tubulointerstitial nephritis and uveitis (TINU) syndrome. Am J Ophthalmol. 2005;140(4):637-41.
    7. Wen YK, Chen ML. IgA-Dominant Postinfectious Glomerulonephritis: Not Peculiar to Staphylococcal Infection and Diabetic Patients. Ren Fail. 2011;33(5):480-5.
    8. Lins RL, Verpooten GA, De Clerck DS, De Broe ME. Urinary indices in acute interstitial nephritis. Clin Nephrol 1986; 26:131.
    9. Cornell LD. IgG4-related kidney disease. Curr Opin Nephrol Hypertens 2012; 21:279.
    10. Flanc RS, Roberts MA, Strippoli GF, et al. Treatment of diffuse proliferative lupus nephritis: a meta-analysis of randomized controlled trials. Am J Kidney Dis. Feb 2004;43(2):197-208.



    Media References

    1. Hunter enlarged kidney, Public Domain

    Languages

    Symptoma
      • Hi, this is Symptoma.