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 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.

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. If you can remember this, the other three features make sense. 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). And as the liver is ramping up its production of protein to make up for the deficit of proteins in the blood, it makes a bunch of albumin but also a bunch of lipoproteins. These circulate in the blood (hyperlipidemia) and eventually get excreted in the urine (hyperlipiduria). 

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, the thing to remember is that it’s caused by increased inflammation (and sometimes an increase in other cell types), in the glomerulus. You can remember this because the suffix “-itic” refers to the leukocytic infiltrate (remember: “-itis” means inflammation). Or just remember that nephrItic and Inflammation both have an “i” in them. All that inflammation injures capillary walls, permitting escape of red cells into urine (hematuria). There may be a little proteinuria too (but it’s not even close to the massive proteinuria seen in nephrotic syndrome). All those cells clogging the glomerulus make it hard for blood to get through, resulting in 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. 

Bottom line: use those vowels!

Remember that nephrOtic syndrome is characterized by massive prOteinuria, and nephrItic syndrome is characterized by Inflammation. Then you’ll have a good shot at remembering the other features.