Nephrotic vs Nephritic Syndrome

This article provides a very brief overview of nephrotic and nephritic syndrome, to help you differentiate the two conditions.

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

Symptoms of nephrotic syndrome can include:

• 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

Clinical signs

Clinical signs of nephrotic syndrome can include:

• 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

Typical findings on urinalysis in the context of nephrotic syndrome include:

• 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

Symptoms of nephritic syndrome can include:

• 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)

Clinical signs

Clinical signs of nephritic syndrome can include:

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

Urinalysis

Typical findings on urinalysis in the context of nephritic syndrome include:

• 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. Available from: [LINK]
2. Dr Colin Tidy. Patient.info. Acute Nephritis. Published: 21st June 2016. Available from: [LINK]