The difference between Nephrotic & Nephritic syndrome is something easy to forget, especially since the words are almost identical. On a simple level, just remember that Nephrotic syndrome involves the loss of a lot of protein, whereas Nephritic syndrome involves the loss of a lot of blood.

Nephrotic Syndrome
Proteinurea (>3.5g in 24hrs)

++++ Protein

Urine looks frothy

Tip: Nephrotic & Protein both have an “O” which may help you remember!


Albumin is lost in the urine

Due to gaps in Podocytes allowing proteins to escape


Swelling around ankles & eyes

Due to loss of albumin

Intravascular oncotic pressure ↓

Fluid moves out of vessels


Due to hypoalbuminaemia, the liver compensates and increases production, however this has the side effect of also increasing the production of lipids, hence causing hyperlipidaemia. 

Nephritic Syndrome

+++ Blood – May be microscopic or macroscopic haematuria

Red cell casts – distinguishing feature, form in nephrons & indicate glomerular damage

Podocytes develop large pores which allow blood & protein through


++ Protein (small amount)


Usually only mild

Low urine volume <300ml/day

Due to renal function been poor

Nephrotic/Nephritic Syndrome in Differential Diagnosis

Nephrotic or Nephritic syndrome are only a collection of signs and do not give a specific diagnosis of a particular disease. However they are useful as a starting point for your differential diagnosis. This is because each is associated with a number of kidney conditions, allowing you to focus upon those conditions first. Below is just a quick overview of which diseases are associated with which syndrome, for more details read the Glomerulonephritis article

Nephrotic Syndrome – associated diseases

Primary causes

Minimal change Glomerulonephritis

Focal Segmental Glomerulosclerosis

Membranous Glomerulonephritis.


Secondary causes


Hep B & C


Diabetes Mellitus


& lots of others

Nephritic Syndrome – associated diseases

Post streptococcal Glomerulonephritisappears weeks after URTI

IgA Nephropathyappears within a day or two after URTI


Rapidly progressive Glomerulonephritis (crescentic glomerulonephritis)

  • Goodpastures anti GBM antibodies against  basal membrane antigens
  • Vaculitic disorder – Wegners granulomatosis, Microscopic Polyangitis, Churg Strauss disease


Membranoproliferative Glomerulonephritis primary or secondary to SLE, Hepatitis B/C etc

Henoch-Schönlein purpura systemic vasculitis – deposition of IgA in the skin & kidneys