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/.
GOOD ! IT WILL HELP ME TO REMEMBER
very cool thanks
very very good
thanks for help
Thank you sooooooooooooo much!!now i’m confidence with my reading after reading ur simplified version
thanx again
good one
THANKS FOR THE HELPS NICE,,,,,,,,,,
very nice explanation))
Thank alot, it has been my problem to get the difference of the two. Well done
thanks a lot..
Thank God I found this page! You made it SO much easier to remember.
thank you,it could be very clear if you add histological cgange.
nyc1,realy lyk it
That was very helpful. Thank you so much!
Thanks learning made easier
thank you..my friends and i were looking for something like this…it helped us a lot!!!
nice !!
very good, simple and useful!
nice ^-^ thank’s
Thanks,realy like it….
OH ! COMPLICATED BUT SIMPLE
Good post- thanks alot.
Also I remember my tutor tellin me that the cause for hyperlipidaemia in NephrOtic syndrome is due to hepatic compensation where by the liver synthesises more ‘proteins’ in the form of lipoproteins (containing apolipoprotein B and cholesterol.
oh sh*t syndrome! lol
its one way dig another answer…anywy thanx !
i just died and went to heaven and found this page! amazing! much appreciated xxx
Thanks so much! this narrows the key concepts.
Thanks soo much! I also agree with FCP about the cause of hyperlipidaemia.
very useful nd impressive
I agree with FCP and Jeremy: In a lecture they told us that the liver is overcompensating (not very selectively) – synthesizing more protein, lipoprotein, and also clotting factors (leads the coagulation problems).
Very good article.
Now that I understood that part, I would love to read an article that goes more in depth on the topic while still having good explanations… (as a suggestion).
I love pathologystudent.com!
Awesome…..!!!!took good nw l nvr frgt these…
You’llmsfe it very simple for me
Now toh I’ll never forget it in my whole lige
thanks alot. you made it so simple
you are so amazingggg .. keep up the good work
I think I will never forget these two syndromes
Awesome… Well done
PERFECT !!!
that’s great! thank u very much!
awesome…gud way to understand..;)
Thnx alot, dat was cul. mayb to add on something;
AGE: Nephritic (AGN) is common in Young children of age 3 – 4yrs
Nephrotic is common in older children >5 yrs.
SEX: Nephritic mostly affect Male.
RESPONSE TO PREDNISOLONE: 98% of Nephritic respond to Steroids.
OMG! really cool. Finally learnt it, makes reading much easier, though haven’t read it indepth yet…u guys r sooo amazing
Thanks for helping me, nice explaination
I don’t know if it will help but one generalization I have used in the past is to think of nephrotic as mostly a GBM disease and nephritic as broader glomerular inflmmation. To help facilitate this into memory I like to think of nephrotic syndrome as a sink with a wide open drain, vs nephritic as a backed up sink.
Crude I know, but it helps remind me of the albumin loss, immunoglobulin loss (infection) & Antithrombin III loss (hyper coag state) on the nephrotic side vs oliguria (leading to most features) on the nephritic side as the key features to remember of each disease.
Additionally I have read the hyperlipidemia is thought to be the liver’s last-ditch effort to conserve falling oncotic pressure though I am not sure this is more than a hypothesis but it makes sense so I stick with it.
Hope the sink analogy works for some of you!
Really when I find that title accidently,i saved it directly coz it always is forgotten,,watever I do,,i always forget it
but now I think I wont ever isa
thank you for this iv known and for good
i love you man
thanks a lot for the whole website!
Lol this is exactly how I remember things! Also in the UK edema is actually oedema (an extra ‘o’ for nephrotic)
Thanks
Wonderful. So helpful
this is very very cool i love it
thank you 4r making easy
excellent….now i understand it very well.thanx a lot!
i loke it. short and clear
now i get the df since many years
Thanks for the help!! I will remember that for sure!