Nephrotic vs Nephritic Syndrome

Medical Student

Sometimes children cannot help but get diseases unknowingly, and doctors come to the rescue to treat them. Most of the common childhood illnesses that we know are fever, colds, flu, and so forth. But organ-based diseases affecting the kidneys, liver, and heart should be treated with expert care and clinical eyes from respected pediatricians.

One of which is the condition affecting a part of the urinary system, the kidneys. These two conditions are common among children ages 2-6 years old. These are the nephritic syndrome and nephrotic syndrome. What are the major differences?

In a nephrotic syndrome, a group of manifestations occur, such as: proteinuria or protein in the urine, edema particularly generalized edema, hypoalbuminemia or low count of albumin in the blood, and lastly hyperlipidemia or too much lipids or fats circulating in the blood. In a nephritic syndrome, all of these occur plus there is hematuria or blood in the urine. Did you understand the difference? It’s very simple to understand and remember.

The cause of a nephrotic syndrome can be primary or secondary. When it is primary, the cause is the kidneys while in secondary other factors, such as: allergy, infections, hepatitis, diabetes, and a lot more have contributed to the disease. The cause of a nephritic syndrome, on the other hand, can be infections, autoimmune diseases, or it can be inherited. The main problem is usually the glomeruli, the structures in the kidneys which filter blood.

Nephrotic syndrome is diagnosed via a 24-hour urine/protein measurement. Other tests are for lipid profiles. For a nephritic syndrome, doctors order urine tests, blood tests, and ASOT or anti-streptolysin O test for infections.

The cure for both diseases are anti-inflammatory drugs and drugs that will help the buildup of edema. Sometimes the cure depends on the cause of the disease which can be infection. Both diseases have a good prognosis, thus both are treatable in children and in adults.

Summary:

1.Nephrotic syndrome is a disease of the kidney while nephritic syndrome is a disease of the glomeruli. Nephritic syndrome is also called glomerulonephritis.
2.Nephrotic syndrome manifests the classic symptoms, such as: edema, proteinuria, hypoalbuminemia, and hyperlipidemia. Nephritic syndrome manifests the same except there is an accompanying blood in the urine.
3.Diagnosis for nephrotic syndrome is a 24-hour urine/protein measurement and lipid profile while a nephritic syndrome involves an ASOT, urine tests, and blood tests.

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

Proteinuria (>3.5g in 24hrs)

++++ Protein

Urine looks frothy

Tip: Nephrotic & Protein both have an “O” which may help you remember!

Hypoalbuminaemia

Albumin is lost in the urine.

Gaps in podocytes allow proteins to leak into the urine.

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

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 and indicate glomerular damage

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

Proteinuria

++ Protein (small amount)

Hypertension

Usually only mild

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.

Nephrotic syndrome – associated diseases

Primary causes

Minimal change glomerulonephritis

Focal segmental glomerulosclerosis

Membranous glomerulonephritis

Secondary causes

SLE

Hep B and C

HIV

Diabetes mellitus

Malignancy

Nephritic syndrome – associated diseases.

Post-streptococcal glomerulonephritis – appears weeks after upper respiratory tract infection (URTI)

IgA nephropathy – appears within a day or two after a URTI

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 and kidneys

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