The difference between acute nephritis and acute pyelonephritis.

Written by Hu Lin
Nephrology
Updated on May 29, 2025
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The full name of acute nephritis is acute glomerulonephritis. This disease mainly occurs in children and is often preceded by an infection, such as an upper respiratory tract infection or a skin infection. Typical clinical manifestations of acute glomerulonephritis include sudden hematuria, proteinuria, edema, hypertension, and some patients may exhibit transient azotemia. The severity of the condition varies among patients, with severe cases presenting as oliguric acute renal failure. Acute pyelonephritis, on the other hand, is a type of urinary tract infection. Its main clinical symptoms are fever, chills, frequent urination, urgent urination, painful urination, difficulty urinating, and may also include nausea, vomiting, headache, and general body aches. Its diagnosis is mainly based on the presence of positive urinary leukocytes in the routine urine test, and a clean-catch midstream urine culture greater than 100,000 per milliliter.

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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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Nephrology
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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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Nephrology
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What are the symptoms of acute nephritis?

Acute nephritis is commonly seen in children, and in cases of acute nephritis in children, it is often preceded by an upper respiratory tract infection or skin infection one to three weeks prior to the onset. Once acute nephritis occurs, the most prominent clinical symptom in patients is gross hematuria, though some individuals only show microscopic hematuria, accompanied by an increase in urinary proteins. Additionally, patients with acute nephritis may experience swelling of the eyelids and lower limbs, especially noticeable swelling of the eyelids and facial area upon waking in the morning. Some patients may also experience elevated blood pressure, leading to symptoms such as dizziness and headache. A few may suffer from nausea, vomiting, loss of appetite, reduced urine output, or even symptoms of acute renal failure.

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What are the symptoms of acute nephritis?

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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Symptoms of Acute Nephritis

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.