Symptoms of Acute Nephritis

Written by Zhou Qi
Nephrology
Updated on September 01, 2024
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Acute nephritis may present with some clinical symptoms. The main characteristics are that patients may have hematuria and proteinuria. When there is a significant amount of blood in the urine, it can be detected by the naked eye, known as gross hematuria. For instance, the color of the patient's urine could be dark like strong tea or bright red. Patients might also experience increased urine foam due to the presence of proteins in the urine, especially in cases where there is a significant presence of urinary proteins. A minority of patients may experience acute renal failure, often characterized by reduced urine output, or even anuria. Due to the reduced urine output, the water intake of patients cannot be fully excreted, leading to edema. Patients may experience swelling of the facial and bilateral lower limbs or even the whole body.

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Written by Zhou Qi
Nephrology
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Causes of Anemia in Acute Nephritis

Patients with acute nephritis often do not experience anemia. If a patient with acute nephritis develops anemia, further examination is necessary to determine whether rapidly progressive glomerulonephritis is present. The mechanisms of anemia include hemorrhagic anemia, anemia due to the destruction and dissolution of red blood cells, and anemia due to decreased bone marrow hematopoietic capacity. Hemorrhagic anemia is commonly seen in cases of excessive menstrual flow or chronic blood in stools, which can occur in conditions such as liver cirrhosis, gastric ulcer, enteritis, and intestinal cancer. Anemia resulting from the breakdown of red blood cells often occurs in cases of splenomegaly or when the body produces antibodies against red blood cells, leading to autoimmune hemolysis. A decrease in bone marrow hematopoietic capacity is typically seen in related diseases such as leukemia, myeloma, or renal anemia, or when the patient's dietary intake of nutrients is insufficient, leading to reduced bone marrow hematopoietic capacity. Overall, for acute nephritis, if anemia occurs, it is important to identify the cause, which may not be closely related to acute nephritis itself.

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Written by Li Liu Sheng
Nephrology
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Symptoms of acute nephritis include back pain.

Patients with acute nephritis usually have hematuria as their main symptom. Initially, the condition presents as gross hematuria, but within 1-2 days, the patient transitions to microscopic hematuria, and the gross hematuria disappears. Patients may also experience edema, particularly noticeable in the eyelids and facial area upon waking up in the morning, along with varying degrees of increased urine protein. Typically, acute nephritis patients may also experience nausea, vomiting, abdominal distension, and discomfort in the lower back, but not back pain per se, as back pain is not a symptom of acute nephritis. However, if a patient with acute nephritis does develop back pain, it is crucial to rule out other diseases, such as kidney stones, ureteral stones, acute pyelonephritis, and acute renal infarction, all of which can cause sudden back pain in patients with acute nephritis. Back pain should be taken seriously, and appropriate exams, such as an immediate ultrasound, should be conducted.

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Written by Li Liu Sheng
Nephrology
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Acute Nephritis Pathological Characteristics

The pathological features of acute nephritis include enlarged kidneys, and under the light microscope, there is diffuse proliferation of glomeruli, capillary endothelial cells, and mesangial cells. During the acute phase, there can be infiltration of neutrophils and mononuclear cells. In severe cases, constriction or occlusion of the capillary loops occurs, and the renal interstitium has edema and infiltration of inflammatory cells. Under immunofluorescence, there are deposits of IgG and C3 appearing as granular deposits along the glomerular capillary walls and mesangial areas. Under electron microscopy, there are hump-shaped electron-dense deposits beneath the glomerular epithelium. Acute nephritis is commonly seen in children, characterized by a sudden onset and symptoms such as hematuria, increased urinary protein, edema, and elevated blood pressure, even transient renal function decline may occur.

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Written by Li Liu Sheng
Nephrology
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Early symptoms of acute nephritis

The occurrence of acute nephritis is related to streptococcal infections and is commonly seen in children. Typically, 1-3 weeks before the onset of acute nephritis, patients often have a history of infections in the throat, upper respiratory tract, or skin. Once acute nephritis occurs, the initial symptoms include hematuria, which can manifest as either gross or microscopic hematuria. There is also the appearance of edema, especially noticeable swelling of the eyelids and facial area upon waking up in the morning, and even a decrease in urine output. Additionally, patients with acute nephritis often experience increased foam in the urine, indicating the presence of proteinuria, as well as general weakness, back pain, nausea, and vomiting. After the onset of acute nephritis, some patients may experience elevated blood pressure and even transient renal failure.

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Written by Li Liu Sheng
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What to do if acute nephritis worsens?

Typically, after two to three weeks of treatment, the condition of most patients with acute nephritis can recover. However, if the condition of acute nephritis worsens, patients should return to bed rest and adopt different treatment methods based on their clinical symptoms. If the patient presents with edema, it is essential to maintain a low-salt diet, with daily salt intake less than 2-3 grams. Additionally, the patient's blood pressure must be addressed. If there is a significant rise in blood pressure, it is advisable to start with a low dose of diuretics, which can facilitate urination, fluid excretion, and lower blood pressure. If blood pressure control is inadequate, calcium channel blockers should be considered. Moreover, if a patient with acute nephritis develops acute renal failure, dialysis treatment may be necessary; similarly, if acute heart failure occurs, medications to control blood pressure and dilate blood vessels should be used to reduce the cardiac workload, thereby facilitating recovery from acute nephritis. (Specific medications should be used under the guidance of a physician.)