Nephritic Syndrome

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The nephritic syndrome is the result of disturbance of glomerular structure that involves reactive cellular proliferation. This causes reduced glomerular blood flow (leading to reduced urine output- oliguria), leakage of red cells from damaged glomeruli (haematuria), and consequent retention of waste products (uraemia).

The low renal blood flow activates the renin- angiotensin system, with fluid retention and mild hypertension.
Small amounts of proteins are also lost in the urine, but this is usually trivial.
The haematuria is not gross and is usually manifest as a smoky brown discoloration of urine.
The nephrotic syndrome is the result of abnormality in GBM or mesangium, such that the glomerulus loses the capacity for selective retention of proteins in the blood. This leads to loss of very large amounts of protein, mostly albumen, in the urine (proteinuria), with consequent loss of protein from the blood (hypoalbumenaemia)leading to oedema.
There is susceptibility to infections because of low levels of immunoglobulins and complement, susceptibility to thrombosis because of increased levels of fibrinogen in the blood, and hyperlipidaemia
due to reduced levels of serum apolipoproteins.

Other indications of renal abnormality are intermittent haematuria and persistent
proteinuria which can be thought of as early partial renal failure. The latter may precede the
development of a nephrotic syndrome.
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