Clinical Manifestations of Nephritic Syndrome in Pediatric Patients
Nephritic syndrome in children presents with hematuria (often gross), hypertension, edema, oliguria, and azotemia—requiring only supportive care with fluid/sodium restriction and blood pressure management, as the condition is typically self-limited. 1
Key Clinical Features
Cardinal Manifestations
- Hematuria: Often gross (visible) hematuria with cola-colored or tea-colored urine; microscopic hematuria with red blood cell casts on urinalysis 1
- Hypertension: Elevated blood pressure requiring antihypertensive therapy and close monitoring 1
- Edema: Typically periorbital and peripheral edema, though less severe than in nephrotic syndrome 1
- Oliguria: Reduced urine output with acute kidney injury 1
- Azotemia: Elevated blood urea nitrogen and creatinine indicating impaired renal function 1
Distinguishing from Nephrotic Syndrome
Critical distinction: Nephritic syndrome differs fundamentally from nephrotic syndrome—nephritic presents with inflammatory glomerular injury (hematuria, hypertension, azotemia), while nephrotic presents with podocyte injury (massive proteinuria >3.5g/day, hypoalbuminemia, hyperlipidemia, severe edema) 2, 3.
Initial Management Approach
Supportive Care Only
The American Academy of Pediatrics recommends supportive care exclusively for nephritic syndrome—no immunosuppression is indicated. 1
- Fluid restriction: Limit fluid intake to prevent volume overload and worsening edema 1
- Sodium restriction: Strict dietary sodium limitation to control hypertension and edema 1
- Antihypertensive therapy: Initiate as needed for blood pressure control 1
- Monitor for complications: Watch for acute kidney injury progression, severe hypertension, and fluid overload 1
Antibiotic Considerations
- Only if active streptococcal infection documented: Prescribe penicillin for 10 days if post-streptococcal glomerulonephritis is confirmed with positive throat culture or rising anti-streptolysin O titers 1
- No prophylactic antibiotics: Do not use antibiotics empirically without documented infection 1
Expected Clinical Course
Most children recover completely within 2-4 weeks without immunosuppression, as nephritic syndrome (particularly post-infectious glomerulonephritis) is self-limited 1. This contrasts sharply with nephrotic syndrome, which requires prolonged corticosteroid therapy.
Common Pitfalls to Avoid
Do Not Confuse with Nephrotic Syndrome
The most critical error is misdiagnosing nephritic syndrome as nephrotic syndrome and initiating inappropriate corticosteroid therapy. Nephritic syndrome does NOT respond to steroids and does not require immunosuppression. 1
Key Differentiating Laboratory Findings
- Nephritic: Hematuria with RBC casts, mild proteinuria (<3.5g/day), normal or mildly reduced albumin, elevated creatinine 1
- Nephrotic: Massive proteinuria (≥3+ on dipstick for 3 days or uPCR ≥2000 mg/g), severe hypoalbuminemia, hyperlipidemia, minimal hematuria 2
Avoid Over-Treatment
Do not initiate the intensive corticosteroid regimens used for nephrotic syndrome (prednisone 60 mg/m²/day for 4-6 weeks followed by alternate-day dosing) 2—these are contraindicated in nephritic syndrome and provide no benefit while exposing patients to unnecessary steroid toxicity.