Acute nephritis clinical manifestations

Written by Li Liu Sheng
Nephrology
Updated on April 12, 2025
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Acute nephritis is commonly seen in pediatric patients. One to three weeks before the onset of acute nephritis, infections often occur in the throat, upper respiratory tract, and skin. Once acute nephritis occurs, the typical clinical manifestations of the patient are hematuria, which can be gross hematuria or microscopic hematuria. There is also edema, especially noticeable swelling of the eyelids and face after getting up in the morning. Due to the edema and reduced urine output, the patient often experiences a significant increase in blood pressure. Of course, in addition to these clinical manifestations, the patient may also experience irritability, back pain, nausea, loss of appetite, and poor spirit. Patients with acute nephritis can also experience severe complications, such as hypertensive encephalopathy, acute heart failure, acute renal failure, etc. Therefore, acute nephritis must be given sufficient attention and actively treated.

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How long does acute nephritis require hospitalization?

Generally speaking, regardless of the disease, the condition is often stable when patients are discharged from the hospital, including the management of acute nephritis. The length of hospital stay for patients with acute nephritis depends on the individual condition of the patient. If the condition of acute nephritis is mild and the patient does not have obvious symptoms, such as mild proteinuria and hematuria, such patients may be hospitalized for about a week. After assessing the condition and predicting gradual improvement, the patient can be discharged. However, if acute nephritis causes some serious complications and the patient's condition is unstable, such as leading to congestive heart failure, some patients may also develop acute renal failure and severe consequences like lung infections. Before these complications are controlled and stabilized, the patient cannot be discharged, and the hospital stay may even exceed one month.

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Symptoms of acute nephritis recurrence

When acute nephritis recurs, patients may experience a series of symptoms similar to those at the onset of the disease. Patients may present with hematuria, including visible hematuria in some cases. Due to the presence of a significant amount of protein in the urine, patients may develop edema in parts like the lower limbs and eyelids, and in severe cases, edema can become generalized. The presence of protein in urine also leads to increased urine foam. Some patients may experience acute renal failure, a dramatic decrease in urine output, and gastrointestinal reactions such as nausea and vomiting. Patients may also develop hypertension and heart failure, among other conditions.

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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 long does hematuria last in acute nephritis?

The condition of acute nephritis is generally quite severe. Patients may experience hematuria and proteinuria, with diffuse cellular proliferation in the glomeruli. However, this disease is self-limiting, and the condition can heal on its own. It is important to control the causes of acute nephritis and the complications it may cause to help patients overcome the difficulties. Afterward, the patients' hematuria and proteinuria could potentially disappear. Generally, it takes about 3 to 4 weeks for the urinalysis to turn negative, and some patients may even take up to six months to recover. If recovery takes more than six months, it is possible that the patient's acute nephritis has become chronic nephritis.

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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.