post-acute nephritis sequelae

Written by Zhou Qi
Nephrology
Updated on February 05, 2025
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Acute nephritis is a self-limiting disease, and most patients can fully recover, so the vast majority of patients generally start to show improvement in routine urine tests three to four weeks after onset, with normal kidney function and resolution of edema, resulting in few, if any, sequelae. Of course, a small number of patients may experience prolonged unhealed conditions that can progress to chronic nephritis. These patients may then develop complications, including hypertension and renal anemia, which are long-term potential issues. However, the vast majority of patients with acute nephritis do not experience complications or sequelae.

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Nephrology
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acute nephritis symptoms

Acute nephritis is commonly seen in children and occurs more in males than females. It typically begins one to three weeks after an infection, mainly due to a post-streptococcal infection. The main symptom of acute nephritis is the appearance of edema, which is often an initial manifestation. Typically, this includes swelling of the eyelids in the morning, sometimes accompanied by mild swelling of the lower limbs. In addition, a urinalysis of patients might reveal blood, which can appear as either gross hematuria or microscopic hematuria. Furthermore, some patients with acute nephritis may also experience elevated blood pressure, primarily related to the edema. If managed through diuretic treatment, conditions may gradually return to normal. In severe cases of acute nephritis, symptoms can include dizziness, hypertensive encephalopathy, and even reduced urine output leading to acute kidney failure. Therefore, it is crucial to give significant attention to patients with acute nephritis and treat them actively to avoid severe complications.

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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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Principles of Acute Nephritis Treatment

The treatment of acute nephritis mainly involves managing the complications of acute nephritis, because acute nephritis itself can potentially heal automatically. The inflammatory reaction in the glomeruli can naturally subside, and proteinuria can decrease, kidney function can recover. However, acute nephritis may cause some complications that could be life-threatening to the patient. Therefore, treatment should focus on these complications to help the patient overcome difficulties, and then wait for the acute nephritis to heal automatically. Common complications mainly include heart failure, high blood pressure, pulmonary infections, etc. Thus, if a patient experiences heart failure, diuretics or even dialysis may be needed, and if an infection occurs, a full course of antibiotics is necessary for anti-inflammatory treatment.

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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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Can acute nephritis be cured completely?

The main cause of acute nephritis is related to streptococcal infections. Many patients with acute nephritis often have a history of infections in the throat, upper respiratory tract, or skin before the onset of the disease. Therefore, once acute nephritis occurs, patients often exhibit hematuria, which can be either gross hematuria or microscopic hematuria. Severe cases of acute nephritis may also show swelling of the eyelids and face, as well as the presence of mild to moderate urinary protein. In addition, some severe cases of acute nephritis also show elevated blood pressure, decreased renal function, and overall poor outcomes from acute nephritis. Currently, there are no specific treatments available; the main approach is bed rest and symptomatic treatment. For example, diuretics can be used if there is edema, and antihypertensive drugs can be used if there is a need to lower blood pressure. If an infection still exists, antibiotics are used for treatment. With proper and standardized treatment, the vast majority of acute nephritis cases can be completely cured without recurrence.