Clinical exam · Kidney, genitourinary, breast and obstetric exam

Nephrotic vs nephritic syndrome !

Syndrome

Two ways the kidney's filter is damaged: one leaks a lot of protein and causes swelling; the other inflames, with blood in the urine and high blood pressure.

Updated 2026-11-01

See it in 3D: Kidneys · Vessels inside the kidney

What it is

Nephrotic and nephritic syndrome are the two main ways glomerular diseases present. Nephrotic syndrome is defined by massive proteinuria, low albumin, marked edema and hyperlipidemia; nephritic syndrome by hematuria with red cell casts, hypertension, moderate edema and a falling filtration rate with oliguria. Telling them apart at the bedside points to the cause, the tests and the outlook, and it is one of the most examined comparisons.

Key findings

Nephrotic: massive proteinuria, hypoalbuminemia, edema, hyperlipidemia and lipiduria.
Nephritic: hematuria with red cell casts, hypertension, edema, oliguria and rising creatinine.
Morning swelling around the eyes in a child suggests nephrotic syndrome; dark urine and hypertension a few weeks after pharyngitis or impetigo suggest post-streptococcal glomerulonephritis.
IgA nephropathy causes gross hematuria a few days after a respiratory infection, unlike the post-streptococcal form, which takes weeks.
Mixed pictures exist: some glomerular diseases (lupus, membranoproliferative) combine features of both.

Pathophysiology

Nephrotic: injury to the podocyte and filtration barrier lets large amounts of protein, mostly albumin, into the urine, without much inflammation.
Low albumin lowers plasma oncotic pressure and the kidney retains sodium; fluid moves into the tissues and edema appears.
The liver makes more lipoproteins (hyperlipidemia); urinary loss of antithrombin and immunoglobulins explains the tendency to thrombosis and infection.
Nephritic: inflammation of the glomerulus, often from immune complexes, breaks the capillary wall; red cells leak into the urine and red cell casts form.
The fall in glomerular filtration causes oliguria and salt and water retention, which produce the hypertension and edema.

Nephrotic vs nephritic: what is seen and what is measured

Feature	Nephrotic syndrome	Nephritic syndrome
Proteinuria	Massive: more than three and a half grams in 24 hours in adults	Moderate, below the nephrotic range
Hematuria	Absent or slight	Present, with dysmorphic red cells and red cell casts
Edema	Marked, soft, up to anasarca	Moderate, around the eyes and in the legs
Blood pressure	Normal or slightly raised	Hypertension is common
Urine output and kidney function	Output preserved; function often normal at first	Oliguria and rising creatinine
Albumin and lipids	Low albumin, high cholesterol and triglycerides, lipiduria	Albumin normal or slightly low
Urine appearance	Foamy	Dark, tea or cola coloured
Typical cause	Child: minimal change disease. Adult: membranous, focal segmental glomerulosclerosis, diabetes	Child: post-streptococcal glomerulonephritis. Adult: IgA nephropathy, lupus, vasculitis

Common causes

Primary nephrotic syndrome: minimal change disease (most common in children), membranous nephropathy and focal segmental glomerulosclerosis (common in adults).
Secondary nephrotic syndrome: diabetic kidney disease, lupus, amyloidosis, chronic infections, some medicines and cancers.
Nephritic syndrome: post-streptococcal glomerulonephritis (mainly in children), IgA nephropathy, lupus nephritis, ANCA-associated vasculitis and anti-glomerular basement membrane disease.
Rapidly progressive glomerulonephritis is a nephritic syndrome with loss of function over days to weeks: a nephrology emergency.

Tests that confirm it

Urinalysis with microscopy: proteinuria, oval fat bodies (nephrotic) or dysmorphic red cells and red cell casts (nephritic).
Protein quantification: 24-hour urine or a spot urine protein-to-creatinine ratio.
Blood: albumin, lipid profile, creatinine; in nephritic syndrome, complement C3 (low in the post-streptococcal form), antistreptolysin, ANA and ANCA.
Kidney biopsy defines the lesion in adults and in children with an atypical course.

Test yourself

Think of the answer, then tap the question to see it.

What are the four features of nephrotic syndrome?

Massive proteinuria, hypoalbuminemia, edema and hyperlipidemia (often with lipiduria).

Which urine microscopy finding is typical of nephritic syndrome?

Red cell casts, together with dysmorphic red cells.

What is the most common cause of nephrotic syndrome in children?

Minimal change disease.

A child has dark urine, puffy eyelids and hypertension three weeks after impetigo. What does this suggest?

Post-streptococcal glomerulonephritis, a nephritic syndrome, typically with low complement C3.

Why is a nephrotic patient at higher risk of thrombosis?

Because anticoagulant proteins such as antithrombin are lost in the urine and the liver makes more procoagulant factors.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

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Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Nephrotic syndrome: MedlinePlus Medical Encyclopedia (MedlinePlus (U.S. National Library of Medicine), 2024); Glomerulonephritis: MedlinePlus Medical Encyclopedia (MedlinePlus (U.S. National Library of Medicine), 2024); Urine - bloody (MedlinePlus (U.S. National Library of Medicine), 2024).

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