Nephritic and nephrotic syndromes

Nephritic syndrome Haematuria (red or brown urine) Oedema and generalised fluid retention Hypertension Oliguria

The complete form is classically seen in post-infectious glomerulonephritis, may occur in acute IgA nephropathy, and occasionally occurs in other types of glomerulonephritis. The presence of one or more features is common to many types of glomerular disease.

Nephrotic syndrome Nephrotic syndrome refers to the secondary phenomena that occur when substantial amounts of protein are lost in the urine

Overt proteinuria: usually > 3.5 g/24 hrs (urine may be frothy) Hypoalbuminaemia (< 30 g/L) Oedema and generalised fluid retention Intravascular volume depletion with hypotension, or expansion with hypertension, may occur

Classically seen in non-inflammatory and subacute inflammatory/proliferative glomerular disorders

Consequences of the nephrotic syndrome and their management Hypoalbuminaemia Urinary protein losses exceed synthetic capacity of liver leads to reduced oncotic pressure & oedema ( can be managed by diuretics and a low-sodium diet ).

Avid sodium retention Secondary hyper-aldosteronism &   additional poorly characterised intra-renal mechanisms lead to oedema . 

Hypercholesterolaemia Non-specific increase in lipoprotein synthesis by liver in response to low oncotic pressure with a consequence of high rate of atherosclerosis that can be managed by Lipid-lowering drugs (e.g. HMG CoA reductase inhibitors).

Hypercoagulability Relative loss of inhibitors of coagulation (e.g. antithrombin III, protein C and S) and increase in liver synthesis of procoagulant factors lead to venous thromboembolism so we must consider prophylaxis in all patients with chronic or severe nephrotic syndrome.

Infection Hypogammaglobulinaemia (urinary losses) leads to Pneumococcal infection( Consider vaccination).

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