Nephrotic Syndrome vs Nephritic Syndrome
Nephrotic Syndrome and Nephritic Syndrome are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Nephrotic Syndrome vs Nephritic Syndrome at a glance
- Nephrotic Syndrome: Heavy proteinuria (>3.5 g/day) with hypoalbuminemia, edema, and hyperlipidemia.
- Nephritic Syndrome: Glomerular inflammation with hematuria, RBC casts, hypertension, and mild-to-moderate proteinuria.
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Side-by-side comparison
| Feature | Nephrotic Syndrome | Nephritic Syndrome |
|---|---|---|
| At a glance | Heavy proteinuria (>3.5 g/day) with hypoalbuminemia, edema, and hyperlipidemia. | Glomerular inflammation with hematuria, RBC casts, hypertension, and mild-to-moderate proteinuria. |
| Classic presentation | Periorbital edema in a child = consider minimal change disease until proven otherwise.; Insidious or rapid-onset peripheral edema — periorbital in morning, dependent later; Foamy or frothy urine (proteinuria); Weight gain, abdominal distention (ascites); Dyspnea (pleural effusions), fatigue; Symptoms of underlying cause: rash, joint… | Tea-colored urine plus periorbital edema and hypertension in a child 1-3 weeks after sore throat — classic for post-streptococcal GN.; Cola-colored, tea-colored, or smoky urine (gross hematuria); Periorbital and peripheral edema; Headache, malaise (from hypertension); Oliguria in severe or rapidly progressive cases; Constitutional… |
| Workup / key labs | Nephrotic syndrome diagnosed by: proteinuria >3.5 g/day, hypoalbuminemia <3.0 g/dL, edema, hyperlipidemia. Kidney biopsy is standard in adults to determine specific pathology and guide therapy (excepting clear diabetic nephropathy).; 24-h urine protein OR spot UPCR (>3.5 g/g diagnostic); Urinalysis with microscopy — oval fat bodies,… | Nephritic syndrome = hematuria (often gross) with RBC casts and dysmorphic RBCs + variable proteinuria + hypertension + azotemia. Kidney biopsy is the definitive test for adults and complicated pediatric cases to determine pattern and guide immunosuppression.; Urinalysis with microscopy — dysmorphic RBCs, RBC casts (diagnostic of… |
| Imaging | Renal ultrasound — assess size, exclude obstruction; Echocardiogram if HF suspected as alternative edema cause | Renal ultrasound to assess size and exclude obstruction; Chest imaging if pulmonary symptoms or suspected pulmonary-renal syndrome |
| First-line treatment | Treat underlying cause — glycemic control in diabetes, antiviral for hepatitis, withdraw offending drug; ACEi (lisinopril, ramipril, enalapril) or ARB (losartan, valsartan, irbesartan) — reduce proteinuria, slow progression; SGLT2 inhibitor — dapagliflozin, empagliflozin — added benefit in proteinuric CKD; Loop diuretic — furosemide,… | Treat underlying etiology — antibiotics for active infection, immunosuppression for autoimmune cause; BP control: ACEi or ARB (lisinopril, losartan); avoid in acute AKI exacerbation; Loop diuretic — furosemide, torsemide — for volume overload; Sodium and fluid restriction; Empiric pulse methylprednisolone (1 g IV daily × 3) for… |
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