What is the difference between Nephrotic Syndrome (characterized by severe proteinuria, hypoalbuminemia, and edema) and Nephritic Syndrome (characterized by hematuria, hypertension, and impaired renal function)?

From the Guidelines

Nephrotic syndrome and nephritic syndrome are two distinct kidney disorders with different clinical presentations, underlying mechanisms, and treatment approaches. The primary characteristics of nephrotic syndrome include heavy proteinuria (>3.5g/day), hypoalbuminemia, hyperlipidemia, and edema, resulting from damage to the glomerular filtration barrier, particularly podocytes, allowing proteins to leak into the urine 1. In contrast, nephritic syndrome is characterized by hematuria (blood in urine), moderate proteinuria (<3.5g/day), hypertension, and often decreased kidney function, stemming from glomerular inflammation, typically involving immune complex deposition and complement activation 1. Some key differences between the two syndromes include:

• Clinical presentation: nephrotic syndrome presents with heavy proteinuria, hypoalbuminemia, and edema, while nephritic syndrome presents with hematuria, hypertension, and decreased kidney function
• Underlying mechanisms: nephrotic syndrome results from damage to the glomerular filtration barrier, while nephritic syndrome results from glomerular inflammation
• Treatment approaches: nephrotic syndrome often requires immunosuppressants, ACE inhibitors, and statins, while nephritic syndrome management focuses on controlling blood pressure, treating underlying infections, and may require immunosuppression depending on the specific cause and severity The treatment approach for nephrotic syndrome should prioritize immunosuppressants like prednisone (starting at 1mg/kg/day), calcineurin inhibitors, or rituximab, along with ACE inhibitors and statins to manage proteinuria and hyperlipidemia, while nephritic syndrome management should focus on controlling blood pressure and treating underlying infections, with immunosuppression considered on a case-by-case basis 1. It is essential to note that the decision to initiate immunosuppressive therapy in patients with nephrotic syndrome should be based on the presence of severe, disabling, or life-threatening symptoms, or a significant decline in kidney function, as outlined in the KDIGO practice guideline 1. In patients with nephritic syndrome, the approach to treatment must be highly individualized, taking into account the underlying cause, severity, and presence of complications such as hypertension or decreased kidney function 1. Overall, a thorough understanding of the differences between nephrotic and nephritic syndromes is crucial for providing optimal care and improving patient outcomes.

From the Research

Nephrotic Syndrome vs Nephritic Syndrome

The key differences between Nephrotic Syndrome and Nephritic Syndrome are:

• Clinical Features: Nephrotic Syndrome is characterized by severe proteinuria, hypoalbuminemia, and edema, frequently in conjunction with hyperlipidemia 2, 3, 4, 5, 6.
• Pathophysiology: Nephrotic Syndrome involves alterations in genes that affect the selectivity of the kidneys and abnormalities in proteins related to podocytes, leading to increased glomerular permeability 2, 6.
• Diagnosis: Diagnosis of Nephrotic Syndrome is based on typical clinical features with confirmation of heavy proteinuria and hypoalbuminemia, and may involve renal biopsy to establish the underlying cause 3, 4.
• Complications: Nephrotic Syndrome is associated with complications such as venous thrombosis, hyperlipidemia, infection, and acute kidney injury 2, 3, 4, 5.

Comparison with Nephritic Syndrome

In contrast, Nephritic Syndrome is characterized by:

• Hematuria: Presence of blood in the urine, indicating inflammation of the glomeruli.
• Hypertension: Elevated blood pressure, which can be a consequence of the underlying kidney disease.
• Impaired Renal Function: Reduced kidney function, which can lead to a buildup of waste products in the body. There are no direct comparisons between Nephrotic Syndrome and Nephritic Syndrome in the provided studies, but the distinct clinical features and pathophysiology of Nephrotic Syndrome are well-documented 2, 3, 4, 5, 6.

Key Characteristics

Some key characteristics of Nephrotic Syndrome include:

• Severe proteinuria (> 3.5 g/24 hours) 3, 6
• Hypoalbuminemia (< 30 g/L) 3, 4
• Edema, frequently in conjunction with hyperlipidemia 2, 3, 4, 5, 6
• Increased risk of infection and thrombosis 2, 3, 4, 5