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Nephritic vs nephrotic syndrome

DimensionNephriticNephrotic
MechanismGlomerular inflammationPodocyte injury and protein leak
UrineBlood, dysmorphic cells, red cell castsHeavy protein, bland sediment, oval fat bodies
ProteinuriaPresent, subnephroticAbove 3.5 g/day
HallmarksHypertension, oliguria, edemaEdema, hypoalbuminemia, hyperlipidemia
CompanionsAKI, complement consumption in some causesThrombosis, infection risk
Classic causesPost-infectious GN, IgA nephropathy, vasculitis, lupusMinimal change, membranous, FSGS, diabetes, amyloid

Pearls

  • Red cell casts prove the nephritic side; heavy protein with bland sediment argues the nephrotic side.
  • Overlap exists (lupus and membranoproliferative patterns can straddle both).

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