Acute Nephritis Causes, Symptoms, and Treatment

Authored by , Reviewed by Dr Laurence Knott | Last edited | Meets Patient’s editorial guidelines

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This article is for Medical Professionals

Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find the Glomerulonephritis article more useful, or one of our other health articles.

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Nephritis essentially means inflammation of the kidney. Nephritis may involve the glomerulus, tubule, or the interstitial renal tissue.

  • When inflammation involves the glomeruli it is called glomerulonephritis.
  • When kidney disease involves structures in the kidney outside the glomerulus, it is broadly referred to as tubulo-interstitial disease. This disease generally involves the tubules and/or the interstitium of the kidney and spares the glomeruli.
  • When inflammation affects the area of the kidney between the nephrons (the renal interstitium) it is known as interstitial nephritis, or sometimes tubulo-interstitial nephritis.

Renal disease can present in a number of different ways, including as:

Glomerulonephritis can present with different clinical syndromes. These include nephrotic and nephritic syndrome. Glomerulonephritis accounts for about 10% of cases of acute kidney injury in adults, mainly related to rapidly progressive glomerulonephritis resulting from granulomatous polyangiitis (GPA, Wegener granulomatosis), microscopic polyangiitis (MPA), and anti-glomerular basement membrane (GBM) disease.[1] Glomerulonephritis is discussed in more detail in the separate Glomerulonephritis article.

Interstitial nephritis can be acute or chronic. Acute interstitial nephritis is commonly due to a drug hypersensitivity reaction and presents as sudden-onset acute kidney injury.[2] Acute interstitial nephritis is estimated to account for 15-20% of cases of acute kidney injury.[3] Acute interstitial nephritis is discussed in detail in the separate Interstitial Nephritides and Nephrotoxins article.

Granulomatous interstitial nephritis (GIN) is rare, detected in 0.5-0.9% of all renal biopsies.[4]

So, nephritis and nephrosis are responses to renal disease or injury. There are a number of underlying disease processes that can lead to both nephritic and nephrotic syndromes.[5] See also separate articles:

Acute nephritic syndrome is often the most serious and potentially devastating form of the various renal syndromes.

The key clinical features of acute nephritic syndrome are:

In primary care

  • Take a history - ask about onset of nephritis symptoms and uraemic symptoms; look for a clue to an underlying cause - eg, recent streptococcal infection, other infection, multisystem disease.
  • Measure blood pressure.
  • Assess for peripheral, periorbital and pulmonary oedema.
  • Perform urine dipstick for protein and blood.
  • If acute nephritic syndrome is suspected, patients should be referred to secondary care. Acute admission may be required.

In secondary care

  • Investigations are focused on assessing severity of renal injury and looking for the underlying cause - discussed in detail in the separate Glomerulonephritis article.
  • Management depends on the underlying cause of acute nephritis and is also discussed in the same article.

This depends on the underlying cause of nephritis. The prognosis for nephritic syndrome caused by acute post-streptococcal glomerulonephritis in children is generally excellent.

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Further reading and references

  1. Pesce F, Stea ED, Rossini M, et al; Glomerulonephritis in AKI: From Pathogenesis to Therapeutic Intervention. Front Med (Lausanne). 2021 Mar 27:582272. doi: 10.3389/fmed.2020.582272. eCollection 2020.

  2. Moledina DG, Perazella MA; Drug-Induced Acute Interstitial Nephritis. Clin J Am Soc Nephrol. 2017 Dec 712(12):2046-2049. doi: 10.2215/CJN.07630717. Epub 2017 Sep 11.

  3. Raghavan R, Eknoyan G; Acute interstitial nephritis - a reappraisal and update. Clin Nephrol. 2014 Sep82(3):149-62. doi: 10.5414/cn108386.

  4. Shah S, Carter-Monroe N, Atta MG; Granulomatous interstitial nephritis. Clin Kidney J. 2015 Oct8(5):516-23. doi: 10.1093/ckj/sfv053. Epub 2015 Jul 5.

  5. Moledina DG, Parikh CR; Differentiating Acute Interstitial Nephritis from Acute Tubular Injury: A Challenge for Clinicians. Nephron. 2019143(3):211-216. doi: 10.1159/000501207. Epub 2019 Jun 14.

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