From the Guidelines
Nephritic syndrome should be managed with a comprehensive approach that includes blood pressure control, immunosuppression, and supportive care, as outlined in the 2021 KDIGO clinical practice guideline for the management of glomerular diseases 1.
Key Components of Management
- Blood pressure control with ACE inhibitors or ARBs, such as enalapril 5-20 mg daily or losartan 25-100 mg daily, to slow disease progression and reduce cardiovascular risk
- Immunosuppression with corticosteroids, such as prednisone 1 mg/kg/day for 4-6 weeks, followed by a gradual taper, for immune-mediated causes
- Supportive care, including sodium restriction (less than 2g daily), fluid management, and diuretics like furosemide 20-80 mg daily for edema
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment are crucial to prevent progression to chronic kidney disease, as some forms of nephritic syndrome can lead to permanent kidney damage if not properly managed 1. Regular monitoring of kidney function, blood pressure, and urinalysis is essential to track disease progression and treatment response.
Considerations for Specific Causes
The 2021 KDIGO guideline provides updated recommendations for the management of specific causes of nephritic syndrome, including IgA nephropathy, membranous nephropathy, and ANCA-associated vasculitis 1. Treatment should be tailored to the underlying cause and may involve targeted therapies, such as B cell-targeted therapies for membranous nephropathy.
From the Research
Nephritic Syndrome
- Nephritic syndrome is a constellation of hematuria, proteinuria, hypertension, and in some cases acute kidney injury and fluid retention characteristic of acute glomerulonephritis 2
- Infection-related glomerulonephritis, IgA nephropathy, lupus nephritis, membranoproliferative glomerulonephritis, and antineutrophil cytoplasmic antibody-associated vasculitis are the most common diseases in nephritic syndrome 2
Comparison with Nephrotic Syndrome
- Nephrotic syndrome consists of peripheral edema, heavy proteinuria, and hypoalbuminemia, often with hyperlipidemia 3
- Nephrotic syndrome may be caused by primary (idiopathic) renal disease or by a variety of secondary causes, including diabetes mellitus, systemic lupus erythematosus, and medication adverse effects 4
- Treatment of nephrotic syndrome typically includes fluid and sodium restriction, oral or intravenous diuretics, and angiotensin-converting enzyme inhibitors, as well as corticosteroid treatment in some cases 4, 3
Treatment and Management
- Treatment of nephritic syndrome depends on the underlying cause, but may include immunosuppressive therapy, such as corticosteroids, and management of hypertension and fluid retention 2
- Renal biopsy may be useful in some cases to confirm an underlying disease or to identify idiopathic disease that is more likely to respond to corticosteroids 4, 3
- Consultation with a nephrologist is recommended for patients with nephritic syndrome, particularly for those with suspected underlying systemic lupus erythematosus or other renal disorders 2, 3