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