136. THE MERCK MANUAL, Sec. 17, Ch. 224, Glomerular Diseases A description of nephritic syndrome with a look at its acute stage, the etiology, signs, symptoms, diagnosis, prognoses and treatment. Also includes crescentic glomerulonephritis and chronic nephritic syndrome. http://www.merck.com/pubs/mmanual/section17/chapter224/224b.htm |
This Publication Is Searchable The Merck Manual of Diagnosis and Therapy Section 17. Genitourinary Disorders Chapter 224. Glomerular Diseases Topics [General] Nephritic Syndrome Nephrotic Syndrome Nephritic Syndrome The classic nephritic syndrome includes hematuria, hypertension, renal insufficiency, and edema. Frequently, individual components of the syndrome are absent. Nephritic syndrome may be acute and transient (eg, postinfectious GN), fulminant with rapid renal failure (eg, rapidly progressive glomerulonephritis [RPGN]), or indolent (eg, IgA nephropathy). Pathologic changes, and therefore clinical manifestations, often vary over time. ACUTE NEPHRITIC SYNDROME (Acute Glomerulonephritis; Postinfectious Glomerulonephritis) A syndrome characterized pathologically by diffuse inflammatory changes in the glomeruli and clinically by abrupt-onset hematuria with RBC casts, mild proteinuria, and, often, hypertension, edema, and azotemia. Etiology The prototype of an acute nephritic syndrome is poststreptococcal glomerulonephritis (PSGN) due to infection with certain nephritogenic strains of group A Pathology and Pathogenesis Lesions are confined mainly to the glomeruli, which become enlarged and hypercellular, initially with neutrophils or eosinophils and later with mononuclear cells. Epithelial cell hyperplasia is a common early, transient feature. Microthrombosis may occur; if damage is severe, hemodynamic changes produce oliguria, frequently accompanied by epithelial crescents (formed within Bowman's space from epithelial cell hyperplasia, probably mediated by growth factors from stimulated macrophages). Endothelial and mesangial cells increase in number, and the mesangial regions often are greatly expanded by edema and contain neutrophils, dead cells, cellular debris, and subepithelial deposits of electron-dense material. | |
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