Nephrotic and nephritic syndromes are common childhood conditions presenting with oedema and proteinuria. However, there are differences between nephrotic syndrome and nephritic syndrome in the clinical features. This article will talk about nephritic syndrome and nephrotic syndrome and the differences between them in detail highlighting their clinical features, causes, investigation, prognosis, and the course of treatment they require.
Nephrotic Syndrome
In nephrotic syndrome, there is heavy protein loss in urine causing low plasma albumin and body swelling. The cause of nephrotic syndrome is unknown. Some cases appear due to henoch schonlein purpura (HSP), systemic lupus erythematosus, allergens and infections. Nephrotic syndrome features swelling around the eyes, scrotum, vulva and lower limbs due to fluid collection. Fluid accumulates in the abdomen (ascites) and pleural cavities (effusion). Urine full report, urine microscopy, culture, urine sodium, full blood count, blood urea, serum electrolytes, creatinine, albumin, complement level, ASOT, throat swab, and hepatitis B antigen are routinely done investigation for nephrotic syndrome.
There are three types of nephrotic syndrome: steroid sensitive, steroid resistance and congenital. Steroid sensitive nephrotic syndrome accounts for about 85-90% of the cases. It is commoner in Asian boys than in girls. Allergies and bronchial asthma are loosely associated with steroid sensitive nephrotic syndrome. As the name implies steroid therapy resolves protein loss. Renal failure is not known in steroid sensitive nephrotic syndrome. Respiratory tract infections usually precede it.
If the patient is between ages 1 to 10, and has no blood stained urine, normal blood pressure, normal complement levels, and normal kidney function nephrotic syndrome is likelier than nephritic syndrome. Gross fluid loss, clotting, infections, high serum cholesterol levels are well known complications of nephrotic syndrome. Natural history of the disease features relapses and remission.
Pediatric nephrological review is needed in the case of steroid resistant nephrotic syndrome. Diuretics remove excess fluid. ACE inhibitors and low salt diet help to control blood pressure. NSAIDs may reduce protein loss in urine.
Congenital nephrotic syndrome is rare and present within the first three months of life. It shows an autosomal recessive inheritance. It is most common in Finns. The prognosis is poor. Sever albumin loss is thought to be related to high mortality. Kidney failure is rare in these patients. Both kidneys may need to be removed to control extreme swelling.
Nephritic Syndrome
Streptococcal pharyngitis or skin infection usually precedes nephritis in kids. Post streptococcal glomerulonephritis is now uncommon in the UK but frequent in developing countries. Henoch Schonlein purpura (HSP), polyarteritis nodosa, microscopic polyarteritis, Wegenr’s granulomatosis, systemic lupus erythematosus, IgA nephropathy, Goodpasture’s syndrome, and mesangiocapillary glomerulonephritis also cause acute nephritis. Acute nephritis reduces glomerular filtration, reduces urine output, increases body fluid volume, elevates blood pressure, and causes fits, hematuria, and proteinuria. Excess fluid should be removed with diuretics with special attention to electrolyte levels. Kidney function may drop drastically in some cases. Irreversible renal failure is the end result, if left untreated.
What is the difference between Nephritic and Nephrotic Syndrome?
• Nephrotic syndrome occurs at a younger age than nephritic.
• Nephrotic syndrome doesn’t elevate blood pressure while nephritic syndrome does.
• Nephrotic syndrome has normal complement levels while nephritic syndrome features low complement levels.
• Nephrotic syndrome doesn’t affect renal function while nephritic syndrome reduces renal function.
• Nephrotic syndrome doesn’t cause hematuria while nephritic syndrome does.
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