A comparison between Nephritic and Nephrotic syndrome from Professor Hossam Mowafy Internal Medicine textbook nephrology section, Please inform me if there is any error or wrong information include.

1. Nephrotic Syndrome POC Nephritic Syndrome
Edema - Hypo-albuminemia Proteinuria
Hypercholesterolemia (not essential)
Characteristic HTN – Mild Edema – Oliguria -
Azotemia - High JVP – Dark Urine
Any Inflammation cause Proteinuria then
Edema then Hypovolemia then more
hypoalbuminemia and hyperlipidemia
Mechanism 2 Immunological disorder Causing Thickening of BM
1. Anti-Basement Membrane antibody
2. Immune Complex (ppt of BM)
High (dt: High oncotic pressure) GFR Low
1. Minimal Change Disease
2. Membranous glomerulonephritis
3. Systemic vasculitis
4. Diabetic Glomerulosclerosis
5. Amyloidosis
6. Drugs: Penicillamine
Captopril – Gold – Tetracycline (outdated)
7. Sarcodiosis
8. Right sided Heart failure
9. Constrictive pericarditis
Causes
Mostly due to
1. Acute Post-streptococcal
Glomerulonephritis
2. Glomerulonephritis in the course of
collage disorder as SLE.
May be rarely due to
3. Viral infection: Hepatitis –
Epstein Barr virus – Cytomegalovirus
4. Parasitic infection of glomerulus:
Plasmodium falciparum.
5. Rapidly progressive GN
6. Acute tubule-interstitial nephtopathy.
Clinical Picture
It is the only clinical Sign
Massive edema, due to:
1.Increase in the Hydrostatic P. is more
than inc. in Oncotic P. at venular end.
2. Decrease in Oncotic P. is more than
dec in Hydrostatic P. at venular end.
Causing lack of fluid return to
circulation caused by Hypo-proteinemia
leading to:
 Hypo-Volemia
 Aldosterone Secretion
Normal - Nephrotic
Site: Around Eyes (at morning)
Hand Dorsum-abdomen-Genitalias then Leg
Resolved edema denote RF not disease
Edema Mild edema, due to:
1. Salt and Water Retention
2. Generalized Vasculitis
3. Heart failure development
Normal due to:
Hypovolemia
If increased may be due to Underlying HTN
or DM or Polyarthritis nodosa
Bp Hypertension (acute rise in youth) dt:
1. Hypervolemia (dt low GFR)
2. Increase in Ren in Secretion
May complicate to: LSHF – RF – Retinal complic. –
Hypertensive ecnephalopathy
Empty Veins and Normal JVP
due to: Hypovolemia
Only is high if the syndrome is cause by
Right-sided HF or pericardial effusion
Congested Neck
Veins and JVP
High due to:
Hypervolemia
With Congested Neck veins as a
characteristic sign
Hypercholesterolemia and Lipid-uria Other Fever - Bilateral Loin Pain
(Edema stretches renal capsule causing pain)

2. Nephrotic Syndrome POC Nephritic Syndrome
Mainly Lab. Clinical: by exclusion Urine Analysis
Usually Normal Volume Low (but above 400cc/day)
Above 3-3.5gm/day (S or NS, S is better) Proteinuria Very low
Normal (slight elevation dt amino acids) Specific Gravity High (as tubules are normal)
Maybe indicating GN as a cause
With Hyaline Cast and THP
RBCs and RC Present: a Sure Diagnostic Sign
(Tamm–Horsfall Protein)
Mostly Normal To assess renal function Urea/Creatinine Elevated in severe cases
Blood
LOW Serum Protein Usually Normal
Normal Sodium Possibly Increase
Decreased Potassium Possibly Increase
Early: normal Later: High dt RF Urea/Creatinine Possibly Increase
High Cholesterol (but not essential)
Low Calcium (but not ionized Ca = no tetany)
Other: Biopsy: Crescent form
Treatment
Water: given with negative balance.
High Protein – High Calcium
Salt Restriction Potassium: given freely
Diet Water: Restricted with negative balance
Less than normal (as pt. is hypervolemic)
Sodium and Potassium restriction
Protein Restriction
Look for the underlying cause
Diuretics: Spironolactone - mannitol
Albumin infusion – Calcium
Antibiotics: as pt is immunocomp.
Empirical Steroids: is the pt is responding?
Drugs Immuno-Suppressor: non-steroidal
Anti-Hypertensive: Best is alpha-methyl
dopa (inc Renal B-flow too) and avoid ACE
Diuretics: avoid cortico-medullary in balance
Antibiotics
Dialysis If Renal Failure occured
Source: Professor Dr.Hossam Mowafy Textbook and Lecture
S
By: Hatem Refaat El-Sheemy
Undergraduate MBBCH – MUST – College of Medicine