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The differences between nephrotic and nephritic syndrome are easily forgotten. At the most basic level, 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.

Gaps in podocytes allow proteins to leak into the urine.

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Oedema

Albumin is lost into the urine.

Hypoalbuminemia results in decreased intravascular oncotic pressure.

As a result fluid moves out of the intravascular compartment and into the surrounding tissues causing oedema.

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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 –  microscopic or macroscopic haematuria

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

Haematuria occurs due to podocytes developing large pores which allows blood and protein to escape into the urine.

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Proteinuria

++ Protein (small amount)

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Hypertension

Usually only mild

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Low urine volume <300ml/day

Due to reduced renal function.

Differential diagnosis of Nephrotic and Nephritic syndrome

Nephrotic or nephritic syndrome can be caused by multiple disease processes . First deciding between nephritic and nephrotic syndrome is a useful starting point for your differential diagnosis. This is because each is associated with a particular subset of diseases. 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

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Nephritic syndrome – associated diseases.

Post-streptococcal glomerulonephritisappears weeks after upper respiratory tract infection (URTI)

IgA nephropathyappears within a day or two after a URTI

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Rapidly progressive glomerulonephritis (crescentic glomerulonephritis)

  • Goodpasture’s syndrome – anti-GBM antibodies against basal membrane antigens
  • Vasculitic disorder – Wegener’s granulomatosis / Microscopic Polyangiitis / Churg Strauss disease

 

Membranoproliferative glomerulonephritis primary or secondary to SLE / Hepatitis B/C

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

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