From the Guidelines
Nephritic and nephrotic syndromes are distinct kidney disorders with different clinical presentations and underlying mechanisms, requiring different treatment approaches to address inflammation, proteinuria, and underlying causes. Nephritic syndrome is characterized by inflammation of the glomeruli, presenting with hematuria (blood in urine), mild proteinuria, hypertension, and often decreased kidney function, typically resulting from immune-mediated damage to the glomerular basement membrane 1. In contrast, nephrotic syndrome is defined by massive proteinuria (>3.5g/day), hypoalbuminemia, edema, and hyperlipidemia, occurring due to damage to the podocytes, leading to increased permeability and protein leakage 1. The causes also differ: nephritic syndrome commonly results from post-streptococcal glomerulonephritis, IgA nephropathy, or lupus nephritis, while nephrotic syndrome is often caused by minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or diabetic nephropathy 1.
Key Differences and Treatment Approaches
- Nephritic syndrome:
- Characterized by inflammation and immune-mediated damage
- Often requires immunosuppression to address inflammation
- Common causes include post-streptococcal glomerulonephritis, IgA nephropathy, or lupus nephritis
- Nephrotic syndrome:
- Defined by massive proteinuria and damage to podocytes
- Management focuses on reducing proteinuria using ACE inhibitors or ARBs, along with diuretics for edema and sometimes immunosuppressive medications depending on the underlying cause
- Common causes include minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or diabetic nephropathy
Recent Guidelines and Recommendations
Recent guidelines, such as those from the KDIGO Clinical Practice Guideline for Glomerulonephritis, recommend considering corticosteroid and immunosuppressive therapy only in idiopathic FSGS associated with clinical features of the nephrotic syndrome 1. The Canadian Society of Nephrology commentary on the 2012 KDIGO guideline suggests that treatment of relapses in nephrotic syndrome should consist of a daily prednis(ol)one dose until remission is achieved, with consideration of supportive care including statins due to the variable response to therapy and potential relapsing-remitting nature of the disease 1.
Conclusion Not Applicable
As per the provided instructions, a conclusion section is not applicable. The focus remains on providing a clear, direct answer based on the strongest and most recent evidence, emphasizing the differences between nephritic and nephrotic syndromes and their respective treatment approaches.
From the Research
Differences between Nephritic and Nephrotic Syndrome
- Nephrotic syndrome is characterized by a triad of clinical features: oedema, substantial proteinuria (> 3.5 g/24 hours) and hypoalbuminaemia (< 30 g/L) 2, 3, 4, 5
- Nephritic syndrome is associated with hematuria and proteinuria and abnormal kidney function and carries poorer prognosis and is typically associated with hypertension 6, 4
- The nephrotic syndrome is defined by the presence of heavy proteinuria (protein excretion greater than 3.0 g/24 hours), hypoalbuminemia (less than 3.0 g/dL), and peripheral edema 4
- Hyperlipidemia and thrombotic disease may be present in nephrotic syndrome 2, 3, 5
- The predominant cause of the nephrotic syndrome in children is minimal change disease, while the most common causes of nephritic syndrome are post infectious GN, IgA nephropathy and lupus nephritis 4
Clinical Presentation
- Patients with nephrotic syndrome typically present with periorbital oedema or dependent pitting oedema, and fatigue 2, 3, 5
- Patients with nephritic syndrome may present with hematuria, hypertension, and reduced kidney function 6, 4
Diagnosis and Management
- Diagnosis of nephrotic syndrome is based on typical clinical features with confirmation of heavy proteinuria and hypoalbuminemia 2, 3, 5
- Renal biopsy may be useful in some cases to confirm an underlying disease or to identify idiopathic disease that is more likely to respond to corticosteroids 2, 3, 5
- Treatment of most patients with nephrotic syndrome should include fluid and sodium restriction, oral or intravenous diuretics, and angiotensin-converting enzyme inhibitors 3, 5