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Overview of Nephritic Syndrome / Nephrotic vs Nephritic Syndrome (Proteinuria, Hematuria, Casts)
Nephritic and Nephrotic Syndromes:
Nephritic and nephrotic syndromes are characterized by different symptoms and laboratory findings, primarily due to varying degrees and types of damage to the glomeruli, the filtering units of the kidneys.
Nephritic Syndrome:
Nephritic syndrome is characterized by inflammation and damage to the glomeruli, causing hematuria, mild to moderate proteinuria, hypertension, and often renal insufficiency.
Key features include:
Hematuria: This is a hallmark of nephritic syndrome and results from damage to the glomerular capillaries.
Proteinuria: Proteinuria in nephritic syndrome is usually mild to moderate (less than 3.5 g/day).
RBC Casts: These can be seen on urine microscopy and indicate glomerular hematuria.
Hypertension: This is common in nephritic syndrome due to sodium and water retention.
Renal Insufficiency: This may be seen as elevated serum creatinine and decreased glomerular filtration rate (GFR).
Nephrotic Syndrome:
Nephrotic syndrome is characterized by damage to the glomerular filtration barrier, resulting in severe proteinuria, hypoalbuminemia leading to edema, hyperlipidemia, and lipiduria.
Key features include:
Proteinuria: Proteinuria is typically severe in nephrotic syndrome (greater than 3.5 g/day), primarily composed of albumin.
Edema: Hypoalbuminemia due to loss of albumin in the urine reduces plasma oncotic pressure, leading to fluid leakage into the interstitial space and causing edema.
Hyperlipidemia and Lipiduria: These occur due to increased synthesis of lipoproteins by the liver in response to hypoalbuminemia and loss of lipoproteins in the urine.
Hypoalbuminemia: This results from the substantial loss of albumin in the urine.
Nephritic vs Nephrotic Syndrome:
While there is some overlap, the key differentiating features between the two syndromes are the severity of proteinuria and the presence of hematuria and hypertension (more common in nephritic syndrome), or edema and hyperlipidemia (more common in nephrotic syndrome). It's also worth noting that some diseases, such as lupus nephritis and membranoproliferative glomerulonephritis, can present with features of both nephritic and nephrotic syndromes.
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