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.
Proteinurea (>3.5g in 24hrs)
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.
+++ 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
Minimal change Glomerulonephritis
Focal Segmental Glomerulosclerosis
Hep B & C
& lots of others.
Nephritic Syndrome – associated diseases.
Post streptococcal Glomerulonephritis – appears weeks after URTI
IgA Nephropathy – appears 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