Confusable diagnoses · PANCE / PANRE

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

FeatureNephrotic SyndromeNephritic Syndrome
At a glanceHeavy proteinuria (>3.5 g/day) with hypoalbuminemia, edema, and hyperlipidemia.Glomerular inflammation with hematuria, RBC casts, hypertension, and mild-to-moderate proteinuria.
Classic presentationPeriorbital edema in a child = consider minimal change disease until proven otherwise.; Insidious or rapid-onset peripheral edema — periorbital in morning,…Tea-colored urine plus periorbital edema and hypertension in a child 1-3 weeks after sore throat — classic for post-streptococcal GN.; Cola-colored,…
Workup / key labsNephrotic syndrome diagnosed by: proteinuria >3.5 g/day, hypoalbuminemia <3.0 g/dL, edema, hyperlipidemia. Kidney biopsy is standard in adults to determine…Nephritic syndrome = hematuria (often gross) with RBC casts and dysmorphic RBCs + variable proteinuria + hypertension + azotemia. Kidney biopsy is the…
ImagingRenal ultrasound — assess size, exclude obstruction; Echocardiogram if HF suspected as alternative edema causeRenal ultrasound to assess size and exclude obstruction; Chest imaging if pulmonary symptoms or suspected pulmonary-renal syndrome
First-line treatmentTreat underlying cause — glycemic control in diabetes, antiviral for hepatitis, withdraw offending drug; ACEi (lisinopril, ramipril, enalapril) or ARB…Treat underlying etiology — antibiotics for active infection, immunosuppression for autoimmune cause; BP control: ACEi or ARB (lisinopril, losartan); avoid in…

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Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants.