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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)

References:

  1. Orth SR, Ritz E. The nephrotic syndrome. N Engl J Med. 1998 Apr 23;338(17):1202-11. [Medline]

  2. Roth KS, Amaker BH, Chan JC. Nephrotic syndrome: pathogenesis and management. Pediatr Rev. 2002 Jul;23(7):237-48. [Medline]

  3. Hricik DE, Chung-Park M, Sedor JR. Glomerulonephritis. N Engl J Med. 1998 Sep 24;339(13):888-99. [Medline]

  4. Jennette JC, Falk RJ. Diagnosis and management of glomerular diseases. Med Clin North Am. 1997 May;81(3):653-77. [Medline]

  5. Isbel NM. Glomerulonephritis--management in general practice. Aust Fam Physician. 2005 Nov;34(11):907-13. [Medline]

  6. Lau KK, Wyatt RJ. Glomerulonephritis. Adolesc Med Clin. 2005 Feb;16(1):67-85. [Medline]

Created: Jan 12, 2007
Last Modified: 11/16/2007