Nephrotic vs. nephritic syndrome

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”Â 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”Â syndrome (again -Â 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 -iticÂ). 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 -Â if you only have enough brain space to remember one feature for each disorder -Â remember that nephrotic syndrome is characterized by massive proteinuria (the “o”Â in nephrotic), and nephritic syndrome is characterized by inflammation (the “-itic”Â 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 atÂ http://www.flickr.com/photos/zachklein/54389823/.

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106 Comments

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FAHEEM RAZA on March 15, 2011 at 3:17 pm

GOOD ! IT WILL HELP ME TO REMEMBER
med student on March 30, 2011 at 12:43 pm

very cool thanks
medshamsstudent on April 6, 2011 at 12:06 pm

very very good

thanks for help
Emiral on April 11, 2011 at 12:11 am

Thank you sooooooooooooo much!!now i’m confidence with my reading after reading ur simplified version 🙂 thanx again
mariam on April 15, 2011 at 12:11 pm

good one
risam gafoor on April 28, 2011 at 1:37 pm

THANKS FOR THE HELPS NICE,,,,,,,,,,
yulia on May 16, 2011 at 8:19 am

very nice explanation))
Mwajuma Abdullahi on May 20, 2011 at 1:52 am

Thank alot, it has been my problem to get the difference of the two. Well done
jashaswi das on May 29, 2011 at 12:50 am

thanks a lot..
Shanti on May 30, 2011 at 7:34 am

Thank God I found this page! You made it SO much easier to remember.
niyoyita faustin on May 30, 2011 at 7:56 am

thank you,it could be very clear if you add histological cgange.
imran on May 30, 2011 at 7:06 pm

nyc1,realy lyk it
Zina on June 4, 2011 at 9:50 am

That was very helpful. Thank you so much!
Basilkingsley on June 17, 2011 at 1:42 am

Thanks learning made easier
Rayya on August 9, 2011 at 3:26 am

thank you..my friends and i were looking for something like this…it helped us a lot!!!
janvi tomar on August 28, 2011 at 12:24 am

nice !!
David on August 31, 2011 at 3:48 am

very good, simple and useful!
Hikari on September 12, 2011 at 2:08 pm

nice ^-^ thank’s
Abdulsalam zainab on September 26, 2011 at 6:24 am

Thanks,realy like it….
TADELE on October 9, 2011 at 6:45 am

OH ! COMPLICATED BUT SIMPLE
FCP on October 21, 2011 at 1:45 am

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.
Arian on October 21, 2011 at 12:14 pm

oh sh*t syndrome! lol
norboo thrinlex on October 23, 2011 at 11:58 am

its one way dig another answer…anywy thanx !
L on October 29, 2011 at 10:08 am

i just died and went to heaven and found this page! amazing! much appreciated xxx
Reonda on November 9, 2011 at 9:23 pm

Thanks so much! this narrows the key concepts.
Jeremy on December 16, 2011 at 9:49 am

Thanks soo much! I also agree with FCP about the cause of hyperlipidaemia.
JAYASHREE.B.K on January 2, 2012 at 5:25 am

very useful nd impressive
val on January 20, 2012 at 8:49 am

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!
saadvik on February 8, 2012 at 11:37 am

Awesome…..!!!!took good nw l nvr frgt these…
atul thakur on February 15, 2012 at 11:47 pm

You’llmsfe it very simple for me
Now toh I’ll never forget it in my whole lige
mansoor on February 27, 2012 at 1:15 am

thanks alot. you made it so simple
Shehab AbdelHaleem on March 18, 2012 at 7:54 am

you are so amazingggg .. keep up the good work 🙂
I think I will never forget these two syndromes 🙂
Docjoe on March 28, 2012 at 12:47 am

Awesome… Well done
Lenka on April 4, 2012 at 11:49 pm

PERFECT !!! 🙂
Sarah on April 5, 2012 at 12:32 am

that’s great! thank u very much!
Esha Gujarathi on April 7, 2012 at 8:45 am

awesome…gud way to understand..;)
Salim Bassadiq Tariq on April 11, 2012 at 1:47 am

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.
Ekilarz on April 20, 2012 at 2:12 am

OMG! really cool. Finally learnt it, makes reading much easier, though haven’t read it indepth yet…u guys r sooo amazing
Rukia gasso on May 16, 2012 at 10:53 am

Thanks for helping me, nice explaination
MZK on May 16, 2012 at 2:30 pm

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!
Riem Gamal on May 16, 2012 at 4:01 pm

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
tsybe mayeya on May 24, 2012 at 2:20 pm

thank you for this iv known and for good
S on May 26, 2012 at 12:23 pm

i love you man 🙂 thanks a lot for the whole website!
Shafi on May 31, 2012 at 6:34 am

Lol this is exactly how I remember things! Also in the UK edema is actually oedema (an extra ‘o’ for nephrotic) 😉

Thanks
s s on June 17, 2012 at 10:04 pm

Wonderful. So helpful
uchenna ndukwe on June 30, 2012 at 1:40 pm

this is very very cool i love it
Rakesh Ranjan on July 7, 2012 at 4:42 am

thank you 4r making easy
helyn on July 10, 2012 at 6:43 pm

excellent….now i understand it very well.thanx a lot!
byiringiro elisaphan on September 22, 2012 at 10:44 pm

i loke it. short and clear
now i get the df since many years
Danette on October 8, 2012 at 12:15 pm

Thanks for the help!! I will remember that for sure!