What are the symptoms of acute nephritis?

Written by Li Liu Sheng
Nephrology
Updated on September 29, 2024
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Acute nephritis is commonly seen in children. Most cases of acute nephritis are preceded by a history of streptococcal infection one to three weeks before the onset. Once acute nephritis occurs, the main symptoms include the development of edema, especially swelling of the eyelids and face after waking up in the morning. Additionally, patients with acute nephritis will also experience hematuria, which can be visible or microscopic, with increased foam in the urine and a change in color, and even a decrease in urine output. Of course, patients with severe acute nephritis will also experience a significant increase in blood pressure, leading to nausea, vomiting, headaches, palpitations, chest tightness, shortness of breath, and an inability to lie flat, resulting in heart failure. Therefore, patients with acute nephritis need to undergo reasonable and standardized treatment to avoid complications.

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Acute nephritis pathological characteristics

The changes in acute nephritis are characterized by diffuse intracapillary proliferative glomerulonephritis, and the main structures in the kidney are the glomeruli, renal tubules, and renal interstitium. Therefore, pathological examination can be divided into light microscopy, immunofluorescence, and electron microscopy examinations. Under light microscopy, the pathological changes in acute nephritis mainly include proliferation of mesangial and endothelial cells in the glomeruli. In the acute phase, there is significant infiltration of neutrophils and mononuclear cells. Masson's trichrome staining can reveal subepithelial immune complex deposits, and there is also edema and infiltration of inflammatory cells in the interstitium; Immunofluorescence examination shows diffuse coarse granular deposits of immune complexes along the capillary walls and in the mesangial areas, mainly composed of IgG and C3; Under electron microscopy examination, there are hump-like electron-dense deposits beneath the epithelial cells.

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How should acute nephritis be treated?

Patients with acute nephritis generally have a good prognosis after reasonable and standardized treatment, and rarely develop into chronic nephritis. The main means of treating acute nephritis is symptomatic supportive care, requiring patients to rest in bed during the acute phase. At the same time, spicy food should be avoided and salt intake should be appropriately controlled. If the patient has an infection, sensitive antibiotics should be actively selected for treatment. Additionally, diuretics can be appropriately used for patients with edema, and if the patient also has hypertension, antihypertensive drugs may be used to keep blood pressure within an appropriate range. Of course, some severe cases of acute nephritis may lead to heart failure or renal failure, in which case dialysis should be actively pursued. (Specific medication use should be carried out under the guidance of a doctor.)

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How is acute nephritis diagnosed?

The diagnosis of acute nephritis is actually not difficult, focusing on the following key points: 1. A history of upper respiratory or skin infections prior to the onset of the disease. 2. Typical manifestations of acute nephritis syndrome, including hematuria, proteinuria, reduced urine output, edema, and elevated blood pressure. Among these, hematuria is the most important basis for diagnosing acute nephritis, which can be gross hematuria or microscopic hematuria, and proteinuria can be mild or severe. 3. During the acute phase, there can be an increase in anti-O and a decrease in serum complement C3 concentration. 4. It commonly affects adolescents and children. 5. Most cases improve or even recover after four to eight weeks of treatment.

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How many days does the fever last in acute nephritis?

Generally speaking, acute nephritis itself does not cause fever symptoms in patients. Acute nephritis can cause visible hematuria and an increase in foamy urine. Some patients may also experience a reduction in urine output, severe edema, kidney failure, and other clinical symptoms. However, fever is not a common symptom caused by acute nephritis itself. If such patients develop a fever, it may be due to lung or gastrointestinal infections caused by acute nephritis, as patients with acute nephritis have lowered immune capabilities and are often prone to bacterial infections in other parts of the body, such as coughing and sputum production. In such cases, the patient might have lung inflammation and would require antibiotic treatment to kill the bacteria. Generally, most patients' conditions can be controlled after 10 to 14 days.

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Does acute nephritis easily lead to excessive internal heat?

What is referred to as "getting heated" generally refers to the appearance of herpes around the mouth. In fact, most people carry the herpes virus, which typically does not flare up under normal circumstances. However, when the body's immune system is weakened, the virus can become active. For example, factors like long-term fatigue, lack of sleep, or other illnesses can lead to the reemergence of these sores. They can also appear during acute nephritis, as this condition involves kidney abnormalities or possible symptoms like blood and protein in the urine. Some patients may also experience reduced urine output and acute kidney failure. During acute kidney failure, the immune system is often weakened, which can lead to the reappearance of herpes around the mouth, commonly known as "getting heated."