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Clinical
Features of Nephrotic and Nephritic
Syndrome
Clinical Features
of
Nephrotic Syndrome
The nephrotic syndrome is a
clinical complex characterized by:
- proteinuria of >3.5 g per 1.73
m2 per 24 h (in practice, >3.0 to
3.5 g per 24 h),
- hypoalbuminemia,
- edema,
- hyperlipidemia,
- lipiduria, and
- hypercoagulability.
Clinical Features of Nephritic
Syndrome
Nephritic syndrome is defined by:
-
hematuria (usually with dysmorphic
RBCs), and
-
RBC casts on microscopic examination
of urinary sediment.
Often one or more elements:
-
mild to moderate proteinuria (subnephrotic
proteinuria of < 3.0 g per 24 h),
-
edema,
-
hypertension,
-
elevated serum creatinine, and
-
oliguria (400 mL/day of urine).
RBCs; red blood cells
Classification of
glomerular disease according to
clinical features
Focal
glomerulonephritis
Active urine
sediment without renal insufficiency
or nephrotic syndrome
-
Less than 15
years - Mild postinfectious
glomerulonephritis, IgA
nephropathy, thin basement
membrane disease, hereditary
nephritis, Henoch-Schönlein
purpura, mesangial proliferative
glomerulonephritis
-
15 to 40 years
- IgA nephropathy, thin basement
membrane disease, lupus,
hereditary nephritis, mesangial
proliferative glomerulonephritis
-
Greater than 40
years - IgA nephropathy
Diffuse
glomerulonephritis
Active urine
sediment with renal insufficiency
and variable proteinuria, which can
include nephrotic syndrome
-
Less than 15
years - Postinfectious
glomerulonephritis,
membranoproliferative
glomerulonephritis
-
15 to 40 years
- Postinfectious
glomerulonephritis, lupus, rapidly
progressive glomerulonephritis,
fibrillary glomerulonephritis,
membranoproliferative
glomerulonephritis
-
Greater than 40
years - Rapidly progressive
glomerulonephritis, vasculitis
(including mixed cryoglobulinemia),
fibrillary glomerulonephritis,
postinfectious glomerulonephritis
Nephrotic
syndrome
Heavy proteinuria,
bland sediment although some
hematuria allowed
-
Less than 15
years - Minimal change disease,
focal glomerulosclerosis,
mesangial proliferative
glomerulonephritis
-
15 to 40 years
- Focal glomerulosclerosis,
minimal change disease, membranous
nephropathy (including lupus),
diabetic nephropathy, preeclampsia,
postinfectious glomerulonephritis
(later stage)
-
Greater than 40
years - Focal glomerulosclerosis,
membranous nephropathy, diabetic
nephropathy, minimal change
disease, IgA nephropathy, primary
amyloidosis or the related
disorder light chain deposition
disease (which can account for 15
to 20 percent of cases in patients
over the age of 60), benign
nephrosclerosis, postinfectious
glomerulonephritis (later stage)
-
Orth SR, Ritz
E. The nephrotic syndrome. N Engl
J Med. 1998 Apr
23;338(17):1202-11.
[Medline]
-
Roth KS, Amaker
BH, Chan JC. Nephrotic syndrome:
pathogenesis and management.
Pediatr Rev. 2002
Jul;23(7):237-48.
[Medline]
-
Hricik DE,
Chung-Park M, Sedor JR.
Glomerulonephritis. N Engl J Med.
1998 Sep 24;339(13):888-99.
[Medline]
-
Jennette JC,
Falk RJ. Diagnosis and management
of glomerular diseases. Med Clin
North Am. 1997 May;81(3):653-77.
[Medline]
-
Isbel NM.
Glomerulonephritis--management in
general practice. Aust Fam
Physician. 2005 Nov;34(11):907-13.
[Medline]
-
Lau KK, Wyatt
RJ. Glomerulonephritis. Adolesc
Med Clin. 2005 Feb;16(1):67-85.
[Medline]
Sponsored Links
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Brenner & Rector's the Kidney, by Barry M. Brenner
7th edition (November 14, 2003)
Comprehensive Clinical Nephrology, by Richard J. Johnson
2nd Bk&Cdr edition (August 1, 2003)
Manual of Nephrology (Spiral Manual), by R. Schrier
6th edition (October 5, 2004)
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