Nephritic Syndrome (NMC Licensing Exams Note)

-

 

Nephritic Syndrome (Nursing Lecture Notes)

Nephritic Syndrome (Nursing Lecture Notes)

Definition

Nephritic syndrome is a renal disorder caused by inflammation of the glomeruli, resulting in leakage of red blood cells and proteins into the urine, reduction in glomerular filtration rate (GFR), and fluid retention. It is important to differentiate this condition from nephrotic syndrome, which is characterized by massive proteinuria and edema.

Key Point: Nephritic = “Inflammation & Blood” → Hematuria + Hypertension + Oliguria

Etiology (Causes)

Nephritic syndrome can occur after infections, autoimmune reactions, or systemic diseases.

  • Post-streptococcal glomerulonephritis (PSGN): follows throat or skin infection with group A beta-hemolytic streptococcus. Common in children.
  • IgA nephropathy (Berger’s disease): hematuria after respiratory or GI infection.
  • Rapidly progressive glomerulonephritis (RPGN): aggressive type with crescent-shaped lesions on biopsy.
  • Systemic diseases: Lupus nephritis, Goodpasture’s syndrome, Vasculitis.

Pathophysiology

Nephritic syndrome results from immune-mediated glomerular injury. Antigen-antibody complexes deposit in the glomerular basement membrane (GBM), activating the complement system. This leads to:

  • Inflammation of glomerular capillaries
  • Damage to GBM → leakage of RBCs and proteins
  • Reduced filtration → oliguria and azotemia
  • Salt and water retention → hypertension and edema

Clinical Features

Nephritic syndrome typically presents with:

  • Hematuria: cola or tea-colored urine due to RBCs
  • Oliguria: urine output less than 400 ml/day in adults
  • Hypertension: from sodium and water retention
  • Edema: often periorbital, may be mild to moderate
  • Proteinuria: present but < 3.5 g/day (not as severe as nephrotic)
  • Systemic symptoms: malaise, headache, flank pain
📌 Mnemonic for Features of Nephritic Syndrome → "PHAROAH"
P – Proteinuria (mild)
H – Hematuria
A – Azotemia
R – RBC casts in urine
O – Oliguria
A – Anti-streptococcal antibodies (PSGN)
H – Hypertension

Investigations

  • Urinalysis: hematuria, RBC casts, mild proteinuria
  • Blood tests: ↑ BUN and creatinine, ↓ GFR
  • Serology: ASO titer (post-strep), ANA (lupus), ANCA (vasculitis)
  • Complement levels: often decreased (especially C3 in PSGN)
  • Renal biopsy: confirms diagnosis and underlying cause

Complications

  • Acute kidney injury (AKI)
  • Chronic kidney disease (CKD) if progressive
  • Hypertensive encephalopathy
  • Heart failure (from severe fluid overload)

Management

Management is both supportive and cause-specific.

  • Blood pressure control: ACE inhibitors, ARBs, diuretics
  • Edema: salt and fluid restriction, diuretics
  • Treat underlying infection: antibiotics for streptococcal infection
  • Immunosuppressive therapy: corticosteroids, cyclophosphamide in lupus or vasculitis
  • Dialysis: in cases of severe renal failure
✅ Exam Tip: Differentiate Nephritic from Nephrotic Syndrome
• Nephritic: Hematuria, mild proteinuria, hypertension, oliguria.
• Nephrotic: Massive proteinuria, severe edema, hypoalbuminemia, hyperlipidemia.
📝 Nursing Considerations:
- Monitor fluid balance strictly (intake/output, daily weight)
- Monitor blood pressure regularly
- Restrict fluids and sodium as ordered
- Provide patient education: importance of follow-up, adherence to medications, diet restrictions
- Emotional support: especially in children and families, as prognosis is generally good in post-streptococcal cases
🚀 Exclusive Offer for NMC 2026 Batch

📢 Join Our Private NMC Prep Group

Preparing for the NMC Licensing Exams 2026?
Get ahead by joining our exclusive private group designed for NMC prep questions, guided discussions, and success strategies.

💰 Current Fee: only 60¢ for this year
⚠️ (Note: Fee may change in the new year)

👉 Join the Premium NMC Prep Group Now

Comments

Post a Comment

Popular posts from this blog

Obstetrics And Pediatric Anatomy NMC Licensing Trial ~ password: nursing123

-
  Nursing Quiz Login to Access the Quiz Enter the password to continue: Login Nursing Quiz (10 Questions) 1. A baby born 8 hours ago was examined and had yellowish discoloration of his eyes. The conclusion is: Pathological jaundice Physiological jaundice Blood incompatibility Correct Answer: A Rationale: Jaundice within 8 hours of life is most likely pathological. 2. A diabetic mother delivered a large-for-date baby. The reason is: Deposition of fats Polycythaemia Hyperinsulinism Correct Answer: C Rationale: Excess glucose leads to foetal hyperinsulinism, causing excessive growth. 3. A 22-year-old food vendor presents with purulent vaginal discharge after intercourse. Gonorrhoea test is positi...
Read more

Surgery and surgical NMC Licensing quiz attempt 1

-
  NMC Surgery & Surgical Nursing Quiz NMC SURGERY & SURGICAL NURSING ~ EliteNurses Consult 1. The reason why patients are placed prone for half an hour 4 times daily after undergoing mid-thigh amputation is to: A. Prevent flexion of contractures B. Improve circulation in remaining tissue C. Ensure optimum stump shape 2. Ama Norya, a 42-year-old mother of three, has been transferred to your ward from the recovery ward after myomectomy. As the recipient Nurse, your first nursing action will be to: A. Check for vital signs B. Assess for pain C. Check rate of IV infusion 3. Fluid replacement for a patient with severe burns during the immediate hypovolemic stage is considered satisfactory if the urinary output is approximately: A. Half the intake B. Equal to the intake C. One-third of intake 4. Which of the following is a feature of pre-eclampsia? A. Increased hepatic transaminases ...
Read more

Types of Jaundice in Pediatrics | Causes, Symptoms & Management

-
  Types of Jaundice in Pediatrics Jaundice in children refers to the yellowish discoloration of the skin, sclera, and mucous membranes due to increased bilirubin levels. It is very common in newborns but can also occur in older children. Below are the main types: 1. Physiological Jaundice Cause: Immature liver enzymes leading to slow bilirubin conjugation. Onset: Appears after 24 hours, peaks at day 3–5, and resolves within 1–2 weeks. Features: Mild, self-limiting, no disease. Management: Monitoring only, usually no treatment. 2. Pathological Jaundice This occurs when bilirubin rises excessively or too early. It is always abnormal. Causes: Hemolytic: ABO or Rh incompatibility, G6PD deficiency, spherocytosis. Infections: Neonatal sepsis, TORCH infections. Metabolic/Liver disease: Crigler–Najjar syndrome, biliary atresia, galactosemia. Features: Appears within 24 hours, bilirubin rises >5 mg/dL/day, lasts >2 ...
Read more