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# 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](https://durgical.com/en/anatomy/kidney/) · [Vessels inside the kidney](https://durgical.com/en/anatomy/intrarenal-arteries-and-veins/)

## Key points

- Nephrotic: protein in the urine, edema, low albumin, high lipids. Nephritic: blood in the urine, hypertension, oliguria.
- Red cell casts mean glomerular inflammation (nephritic).
- Nephrotic child: minimal change. Nephrotic adult: membranous and focal segmental glomerulosclerosis; in diabetes, diabetic kidney disease.
- Post-streptococcal: weeks after pharyngitis or impetigo, low C3. IgA: a few days after a respiratory infection, normal C3.
- Nephrotic syndrome predisposes to thrombosis (including renal vein thrombosis) and infection.

## 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.

## Memory aid

NephrOtic: 'O' for overflowing protein and swelling everywhere. NephrItic: 'I' for inflammation, blood and high pressure.

## 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.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/clinical-exam/nephrotic-vs-nephritic-syndrome/)

## See it in 3D

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

- [Kidneys](https://durgical.com/en/anatomy/kidney/)
- [Vessels inside the kidney](https://durgical.com/en/anatomy/intrarenal-arteries-and-veins/)

## Related

- [Edema: pitting, grading and distribution](https://durgical.com/en/clinical-exam/edema-pitting-grading-and-distribution/)
- [Urinary symptoms: dysuria, frequency, oliguria and hematuria](https://durgical.com/en/clinical-exam/urinary-symptoms-dysuria-frequency-oliguria-and-hematuria/)
- [Uremic syndrome and the signs of chronic kidney disease](https://durgical.com/en/clinical-exam/uremic-syndrome-and-the-signs-of-chronic-kidney-disease/)
- [Blood pressure measurement](https://durgical.com/en/clinical-exam/blood-pressure-measurement/)
- [Dehydration and fluid overload](https://durgical.com/en/clinical-exam/dehydration-and-fluid-overload/)

## Related conditions

- [Nephrotic syndrome](https://durgical.com/en/conditions/nephrotic-syndrome/)
- [Post-streptococcal glomerulonephritis](https://durgical.com/en/conditions/post-streptococcal-glomerulonephritis/)
- [Minimal change disease](https://durgical.com/en/conditions/minimal-change-disease/)
- [Membranous nephropathy](https://durgical.com/en/conditions/membranous-nephropathy/)
- [Focal segmental glomerulosclerosis](https://durgical.com/en/conditions/focal-segmental-glomerulosclerosis/)
- [IgA nephropathy](https://durgical.com/en/conditions/iga-nephropathy/)
- [Lupus nephritis](https://durgical.com/en/conditions/lupus-nephritis/)
- [Rapidly progressive glomerulonephritis (anti-GBM, ANCA)](https://durgical.com/en/conditions/rapidly-progressive-glomerulonephritis/)
- [Diabetic kidney disease](https://durgical.com/en/conditions/diabetic-kidney-disease/)

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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](https://medlineplus.gov/ency/article/000490.htm) (MedlinePlus (U.S. National Library of Medicine), 2024); [Glomerulonephritis: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000484.htm) (MedlinePlus (U.S. National Library of Medicine), 2024); [Urine - bloody](https://medlineplus.gov/ency/article/003138.htm) (MedlinePlus (U.S. National Library of Medicine), 2024).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/nephrotic-vs-nephritic-syndrome/