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Nephrotic vs Nephritic Syndrome

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This article provides a very brief overview of nephrotic and nephritic syndrome, to help you differentiate between them.


Nephrotic syndrome

Nephrotic syndrome is a condition involving the loss of significant volumes of protein via the kidneys (proteinuria) which results in hypoalbuminaemia. The definition of nephrotic syndrome includes both massive proteinuria (≥3.5 g/day) and hypoalbuminaemia (serum albumin ≤30 g/L). 1

Clinical Features

As a result of hypoalbuminaemia, nephrotic syndrome is associated with oedema (due to reduced oncotic pressure), hyperlipidaemia and hypercoagulability.

Symptoms

  • Peripheral oedema (more common in adults)
  • Facial oedema (more common in children)
  • Frothiness of urine
  • Fatigue
  • Poor appetite
  • Recurrent infections (due to immune dysfunction)
  • Venous or arterial thrombosis (e.g. myocardial infarction, deep vein thrombosis) due to hypercoagulability

Signs

  • Oedema (e.g. peri-orbital, lower limb, ascites)
  • Xanthelasma and/or xanthoma
  • Leukonychia
  • Shortness of breath (with associated chest signs of pleural effusion – e.g. stony dullness in lung bases)

Urinalysis

  • Proteinuria (protein ++++)
  • Frothy appearance

Nephritic syndrome

Nephritic syndrome is a condition involving haematuria, mild to moderate proteinuria (typically less than 3.5g/L/day), hypertension, oliguria and red cell casts in the urine.

Clinical Features

Symptoms

  • Haematuria (can be frank haematuria or microscopic)
  • Oedema (to a lesser extent compared to nephrotic syndrome)
  • Reduced urine output
  • Uraemic symptoms (e.g. reduced appetite, fatigue, pruritus, nausea)

Signs

  • Haematuria (either visible or detectable on urinalysis)
  • Oedema
  • Hypertension
  • Oliguria (<300mls/day)

Urinalysis

  • Haematuria (blood +++)
  • Proteinuria (mild – protein ++)
  • Red cell casts – distinguishing feature of nephritic syndrome, form in nephrons and indicate glomerular damage

References

  1. Nishi S, Ubara Y, Utsunomiya Y, et al; Evidence-based clinical practice guidelines for nephrotic syndrome 2014. Clin Exp Nephrol. 2016 Jun20(3):342-70. doi: 10.1007/s10157-015-1216-x.
  2. Dr Colin Tidy. Patient.info. Acute Nephritis. Published: 21st June 2016. Available from: [LINK]

 

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