Renal Neph vs Nephritic

Published on October 26th, 2010 | by Lewis Potter

Nephrotic vs Nephritic Syndrome

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!

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Hypoalbuminaemia

Albumin is lost in the urine

Due to gaps in Podocytes allowing proteins to escape

.
Oedema

Swelling around ankles & eyes

Due to loss of albumin

Intravascular oncotic pressure ↓

Fluid moves out of vessels

.
Hyperlipidemia

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
Haematuria

+++ 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

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Proteinurea

++ Protein (small amount)

.
Hypertension

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

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Nephrotic Syndrome - associated diseases

Primary causes

Minimal change Glomerulonephritis

Focal Segmental Glomerulosclerosis

Membranous Glomerulonephritis.

 

Secondary causes

SLE

Hep B & C

HIV

Diabetes Mellitus

Malignancy

& lots of others

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Nephritic Syndrome – associated diseases
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Post streptococcal Glomerulonephritisappears weeks after URTI

IgA Nephropathyappears within a day or two after URTI

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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


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