Acute Nephritis Pathological Characteristics

Written by Li Liu Sheng
Nephrology
Updated on October 22, 2024
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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 Hu Lin
Nephrology
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What causes acute nephritis?

The full name of acute nephritis is post-infectious glomerulonephritis, so as the name suggests, acute nephritis is related to infections. The most common cause is acute streptococcal infection. There are also infections caused by Staphylococcus aureus, Staphylococcus epidermidis, and Gram-negative bacteria. The main pathogenic mechanism is due to a series of immune responses caused by streptococcal infections, leading to an immune complex-mediated glomerulonephritis. The most common sites of infection are the respiratory tract and skin, with a latent period of one to three weeks.

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Written by Hu Lin
Nephrology
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Symptoms of acute nephritis.

The symptoms of acute nephritis are mainly manifested as acute nephritic syndrome, that is, hematuria, proteinuria, edema, hypertension, and transient acute kidney injury. Hematuria is a symptom present in almost all cases of acute nephritis, but it is mostly microscopic hematuria, meaning during examination, the routine urine analysis shows positive occult blood, or red blood cells are found in the urinary sediment. About 40% of the patients may exhibit gross hematuria, where the urine color appears like wash-water or may be bright red, deep tea-colored, and so on. The second symptom is proteinuria, which is also often indicated by a positive urine protein test during routine checks. The third symptom is edema, an early symptom of acute nephritis. Mildly, it presents as swelling of the eyelids in the morning and can spread to the whole body if severe. The fourth symptom is hypertension, with about 80% of patients showing a moderate increase in blood pressure. In severe cases, patients might experience oliguria, with urine output less than 400ml/d, accompanied by transient mild increases in blood creatinine and urea nitrogen, indicating acute kidney injury. This condition is mostly self-limiting, and many patients can recover within a few weeks.

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Written by Zhou Qi
Nephrology
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Acute nephritis has the following characteristics:

Acute nephritis has the following characteristics: First, patients with acute nephritis often have a history of a precursor upper respiratory tract infection. After catching a cold, patients may develop hematuria, proteinuria, or anuria. Second, patients with acute nephritis will experience a decrease in complement C3 in the blood. After recovery from acute nephritis, complement C3 can restore itself. Third, acute nephritis is self-limiting; generally, the patient's condition will gradually improve over three to four weeks, and recovery can be complete after eight weeks. However, a very small number of patients might experience prolonged illness, evolving into chronic nephritis. Fourth, the pathological characteristic of acute nephritis is diffuse proliferation of capillary endothelial cells, which is a manifestation of pathological damage to the glomeruli.

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Written by Li Liu Sheng
Nephrology
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How long should one with acute nephritis stay in bed for rest?

After the onset of acute nephritis, patients should rest in bed for 2-3 weeks until gross hematuria disappears, blood pressure returns to normal, and edema subsides. If the patient's condition is severe, with complications such as high blood pressure, noticeable edema, and significant hematuria, then bed rest should be extended to 4-6 weeks. Bed rest can increase renal blood flow and improve kidney function, which is beneficial for enhancing treatment effectiveness. Gradually, indoor activity can be increased. If the condition does not worsen after 1-2 weeks, the patient may begin outdoor activities. Patients with mild residual proteinuria and microscopic hematuria should be followed up and closely observed without the need for indefinite bed rest. If urine changes worsen again after activity, further bed rest is necessary. For students who develop acute nephritis, it is advisable to take a break from school to ensure enough rest time for recovery.

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Written by Li Liu Sheng
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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.