Nephritic vs. Nephrotic syndromes for the USMLE CK exam

by / Thursday, 15 July 2010 / Published in Internal Medicine

Nephritic and Nephrotic Syndromes:

Nephrotic: Defined by – hyperproteinuria, hypoproteinemia, hyperlipidemia, edema

  • Proteinuria >3.5g/day
  • Patient has generalized edema
  • Hypercoagulation
  • Decreased albumin
  • Hyperlipidemia

Diagnosis:

  • Best initial test is a urinalysis showing significantly increased levels of protein
  • Next best step is a spot-urine test for a protein: creatinine >3.5:1
  • 24-hr urine protein collection >3.5g
  • Most accurate test – Renal biopsy
TYPE OF NEPHROTIC DISEASE COMMON CHARACTERISTICS/TX
Minimal Change Disease This is seen in young children.

Treat with prednisone

Focal Segmental Glomerulosclerosis Similar in presentation to MCD but occurs in adults.

Most commonly idiopathic.

Commonly presents in young hypertensive males.

Treat with prednisone and cyclophosphamide

Membranous Glomerulonephritis Is the most common 1° cause of nephritic syndrome in adults.

A slowly progressive disorder.

Many causes: HBV, HCV, syphilis, certain drugs, malignancies, SLE.

Treat with prednisone + cyclophosphamide.

50% of cases progress to end-stage renal failure

Membranoproliferative Glomerulonephritis Type 1 is slowly progressive while Type 2 is aggressive.

Autoantibody against C3 convertase (decr C3 levels)

Treat with prednisone, plasmapharesis.

Treatment:

  • Protein and salt restriction
  • HMG-CoA reductase inhibitor for hyperlipidemia

Nephritic:

  • This happens when there is diffuse glomerular inflammation

Signs and Symptoms:

  • There is an acute-onset of hematuria
  • Oliguria
  • Hypertension
  • Edema
  • Decreased GFR
  • Increased Bun:Cr
TYPE OF NEPHRITIC DISEASE COMMON CHARACTERISTICS/TX
Post-streptococcal Glomerulonephritis An acute condition.

Classically occurs after Strep Pyogenes infection.

Immunofluorescence shows coarse granular IgG or C3 deposits.

Labs show increased red cells and casts, decreased serum C3, incr ASO titer.

Rapidly Progressive Glomerulonephritis (Crescentic) A nephritic condition that progresses rapidly to renal failure.

Goodpasture’s disease is in this category.

Immunofluorescence shows smooth and linear IgG deposits.

Treat with prednisone and plasmapharesis.

Berger’s Disease (IgA nephropathy) Most common type of nephropathy.

IgA deposits in mesangium.

Presents with recurrent hematuria + low-grade proteinuria.

Usually harmless, however 1 in 4 may progress to renal failure.

Treat with prednisone

Henoch-Schonlein Purpura Always in children, is an IgA nephropathy.

Presents with abdominal pain, GI bleed, vomiting, and hematuria.

Classically find palpable purpura on buttocks and legs

Is a self-limiting disease that requires no steroids.

Multiple Myeloma There is an increased light-chain production.

Find Bence-Jones protein in urine.

Hypercalcemia seen.

Patient becomes succeptible to encapsulated bacteria because there is a defect in normal antibody production.

Treatment must be on the underlying myeloma.

One Response to “Nephritic vs. Nephrotic syndromes for the USMLE CK exam”

  1. Alecisa Comeaux says : Reply

    This was very very helpful! Thanks!

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