frustrated Nephrotic vs. nephritic syndrome

Here’s one of those things in pathology that will lead you to pull all your hair out: what is the difference between nephrotic and nephritic syndrome?

Ugh. They both involve the kidney, they both are syndromes so they’re probably both constellations of findings, and the names are maddeningly similar except for one stinking vowel. How can a person be expected to memorize these things?

Let’s start with the main features of each syndrome. We’ll pick four features for each, since it’s really hard to remember more than four of anything.

Nephrotic syndrome:

1. Massive proteinuria
2. Hypoalbuminemia
3. Edema
4. Hyperlipidemia/hyperlipiduria

Nephritic syndrome:

1. Hematuria
2. Oliguria
3. Azotemia
4. Hypertension

How do you make these lists hang together in a way that you can remember?

First, let’s take nephrotic syndrome. The thing to remember for this one is massive proteinuria. You might do this by remembering that nephrotic and protein both have an “o” in them. The massive proteinuria in these patients leads to hypoalbuminemia (they are peeing out albumin!), which results in edema (the oncotic pressure in the blood goes down, and fluid leaks out of the vasculature into the surrounding tissue). So right there, you have three of the four features, just by remembering one. The cause of the last feature, hyperlipidemia/hyperlipiduria, is less well-understood, so you’re just going to have to memorize that one. As an aside, nephrotic syndrome is often more dangerous than nephritic syndrome, so you might want to think of this syndrome as the “oh sh*t” syndrome (again – nephrotic has an o in it, nephritic does not). Crude, but if it works, who cares?

In nephritic syndrome, there is some proteinuria and edema, but it’s not nearly as severe as in nephrotic syndrome. The thing with nephritic syndrome is that the lesions causing it all have increased cellularity within the glomeruli, accompanied by a leukocytic infiltrate (hence the suffix “-itic”). The inflammation injures capillary walls, permitting escape of red cells into urine. Hemodynamic changes cause a decreased glomerular filtration rate (manifested clinically as oliguria and azotemia). The hypertension seen in nephritic syndrome is probably a result of fluid retention and increased renin released from ischemic kidneys.

If you really want to pare it down – if you only have enough brain space to remember one feature for each disorder – remember that nephrotic syndrome is characterized by massive proteinuria (the “o” in nephrotic), and nephritic syndrome is characterized by inflammation (the “-itic” in nephritic). Then at least you’ll have a shot at remembering the other features.

Note: The image above is of Streeter Seidell, a comedian, and was taken by Zach Klein. It can be found at http://www.flickr.com/photos/zachklein/54389823/.

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76 Responses to Nephrotic vs. nephritic syndrome

  1. fahimeh says:

    hi very good. but i have a question.in nephritic syndrom i tough that inflamation cause increase permibility of vessel and RBC can cross from it then we have hematurea but why don have proteinoria greater than nephrotic syn?why we have masive proteinuria but no hematuria?

  2. salih says:

    thanks for your time and knowledge.

  3. Vanessa Berg says:

    Fantastic!! You should write a book

  4. Kristine says:

    I think it has a lot to do with the GFR. The GFR is pretty low in nephritic syndromes – so not a lot of albumin is actually able to get out into the urine. The vessels in nephritic syndrome are clogged with cells – and the membranes are damaged enough to let out the red cells. Conversely, the vessels are not really clogged with blood in nephrotic syndrome – and the endothelial damage is smaller scale, so it’s easy for protein (but not red cells) to get out.

    It also probably has something to do with complement activation. In some cases of glomerulonephritis, complement is able to generate a massive leukocyte infiltration (leading to a decreased GFR), whereas in other cases, complement doesn’t really generate that type of response (but still damages the membranes enough to let protein out).

  5. fran says:

    Very helpful! Thank you for posting this!

  6. bayan says:

    amazing thank you

  7. mulugeta giday says:

    previously i was confused by the deference b/n the two syndrome but now i get the deference

  8. odu ifeanyi says:

    It was good to point out that there are mild to modrate protinuria and edema in nephritic syndrome..and ‘kristine’ also pointed out that the increase in GFR in nephrotic and decrease GFR in nephritic determine levels of leakage of fluid(edema),protein(protienuria) and red cells(hematuria) …I must add that these syndromes mainly depend on the state and condition of the glomerulus (where the ultrafiltration occur)…thank you for ur time..I won’t forget the oh’shit in a hurry.thanks again

  9. melly says:

    thanks so much

  10. Pek says:

    Hyperlipidemia is due to increased production of LDL and VLDL by the liver in response to hypoalbuminemia

  11. Kristine says:

    Thanks Pek! You’re right – the liver gears up its protein production to replace the lost albumin. Why it would make LDL and VLDL too, though, just because it’s making albumin…it still doesn’t quite sink through my thick head.

  12. Grey Owl says:

    Hi Pek & Kristine, according to my Dr, hyperlipidemia occurs in response to hypoalbuminemia because the liver, in compensation, increases its production of protein stuff (including albumin & lipoproteins). Albumin still leaks out due to Nephrotic Syndrome, while the LDLs aren’t as leaky compared to albumin. That’s why we get hyperlipidemia. Correct?

  13. Kristine says:

    Yes – that is what most sources say. Thanks!

  14. Erum says:

    thanks alot….. very nicely explained…..

  15. aruna pandiyan says:

    clearly explained & easy to understand ….. nice

  16. Dianela Oquendo Cepero says:

    Thank You very much =). I really have fun learning through pathologystudent.com!

  17. Mark says:

    I guess the lost proteins include the lipoprotein as well. So liver tries to produce more lipoprotein. Two raw materials we need for lipoprotein production: lipid and protein. As the body don’t hv enough protein raw material, hence the lipid level rises. This is just my assumption.

  18. keneth kutesa says:

    Thanks for the updates i appreciate , to pathologystudent.com

  19. Gary says:

    In regards to why nephrotic syndrome produces a hyperlipidemia, I beleive the true answer to that questions is unknown. But it serves as a useful memory tool to think that the low albumin caused the liver to go into overdrive in general protein synthesis, thus producing hyperlipidemia. I personally do not know the answer, but I have have a hard time accepting that a fully functioning liver is so sloppy. Afterall, if that were the case would we not expect to see a rise in all proteins make my the liver, such a clotting factor, which do not rise in nephrotic syndrome. I think a better GUESS would be that albumin, which functions not only as a carrier for lipid soluable proteins, vitamins, and drugs, but it also has its hand in transporting a certain percent of the serum cholesterol (and possibly triglycerides). Thus the loss of albumin would result in a loss of cholesterol/lipid carriers in the body. As a result there would be an increased demand for lipoproteins, which would result in an upregulation of lipoprotien synthesis, as well as albumin. As mentioned elsewhere, the liver upregulates albumin synthesis, but the glomerulus continues to lose albumin, but lipoproteins are way too large to pass through the glomerulus. Therefore they increase in concentration while the albumin decreases.

  20. Gary says:

    Also remember, that steroids, many of which use albumin as a primary transporter, are derived from cholesterol. Thus is makes sence that albumin would transport a portion of the bodies cholesterol.

  21. Ama Emilia says:

    Hi dear friend, l must thank u. The explanation is quite funny n dat makes it sink better. Tnx dearie, l need more of this.

  22. Well written. Hyperlipidemia is in response to the overall drop in serum protein caused by proteinurea/hypoalbuminemia. Lipoproteins are produced by the liver, which results in hyperlipidemia/hyperlipidurea.

  23. bestwn says:

    it was helpful , God help you

  24. Jonas says:

    Good stuff! I would also recommend that people use this to remember thrombophilia in nephrotic syndrom, due to loss of antithrombin III.

  25. maro says:

    it is very helpful, i enjoyed the discussion.

  26. Dr.Machani says:

    u made my day easier while doin my peads pper

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