Nephrotic vs. Nephritic syndrome | Symptoms, diagnosis, causes, treatment | Visual explanation

Dr. Paulien Moyaert
15 Aug 202208:59
EducationalLearning
32 Likes 10 Comments

TLDRThe video script discusses the differences and characteristics of nephrotic and nephritic syndromes, both of which can be confusing due to their renal implications. Nephrotic syndrome is marked by excessive protein in urine due to increased permeability of the glomerulus, leading to proteinuria, low blood albumin levels, and fluid retention, which can cause swelling and ascites. Nephritic syndrome, on the other hand, involves inflammation of the glomerulus, resulting in hematuria and a decrease in urine output, which may lead to hypertension. The script outlines various causes for each syndrome, including primary and secondary factors, and emphasizes the importance of diagnostic tests like urine and blood tests, renal biopsy, and imaging studies. Treatment typically involves addressing the underlying cause, using diuretics, ACE inhibitors, and in some cases, corticosteroids or cytotoxic agents. The summary highlights the clinical signs, diagnostic process, and treatment strategies for these renal conditions.

Takeaways
  • 🧬 **Nephrotic vs. Nephritic Syndrome**: Nephrotic syndrome is characterized by excess protein in urine, while nephritic syndrome is marked by excess blood in urine.
  • 🛡️ **Kidney Function**: Normally, the glomerulus filters blood without allowing protein to pass into urine due to the size of protein particles.
  • 🚨 **Nephrotic Syndrome Injury**: Increased permeability of the glomerulus capillary wall leads to protein leakage, causing proteinuria with foamy urine as a clinical sign.
  • 📉 **Albumin & Cholesterol Levels**: Excessive protein excretion in nephrotic syndrome results in low blood albumin levels, with the liver compensating by increasing albumin synthesis and releasing more cholesterol and triglycerides.
  • 💧 **Fluid Retention & Edema**: Low albumin levels cause fluid to leave the bloodstream, leading to fluid retention, possible ascites, pleural effusion, and tissue swelling influenced by gravity.
  • 🩸 **Nephritic Syndrome Injury**: Glomerular injury in nephritic syndrome presents as inflammation (glomerulonephritis), which can lead to edema, low urine volume, and hematuria.
  • 🔬 **Diagnostic Methods**: Diagnosis involves urine and blood tests, with a 24-hour urine collection or a protein/creatinine ratio used to measure protein loss.
  • 🏥 **Causes of Syndromes**: Nephrotic syndrome can be primary or secondary, with common causes including focal segmental glomerulosclerosis, membranous nephropathy, minimal change disease, diabetes, and certain infections.
  • 💊 **Treatment Approach**: The first line of treatment for both syndromes is addressing the underlying cause, often辅以 diuretics and ACE inhibitors to manage fluid retention and blood pressure.
  • 🍽️ **Diet & Lifestyle**: General therapy includes a diet low in saturated fat, cholesterol, and sodium.
  • 🧫 **Renal Biopsy**: Often used in nephritic syndrome for definitive diagnosis, distinguishing between primary and secondary causes, and assessing inflammation and fibrosis levels.
Q & A

  • What is the primary difference between nephrotic and nephritic syndrome?

    -Nephrotic syndrome is characterized by an excess amount of protein in the urine, while nephritic syndrome is characterized by an excess amount of blood in the urine.

  • Why is protein usually not found in urine during normal blood filtration?

    -Protein particles in the blood are too large to pass through the tiny holes of the glomerulus, which is part of the kidney's filtration system.

  • How does nephrotic syndrome increase the permeability of the glomerulus?

    -In nephrotic syndrome, kidney injury causes an increase in permeability of the capillary wall of the glomerulus, allowing too much protein to leak from the blood into the urine.

  • What is one of the main clinical signs of proteinuria associated with nephrotic syndrome?

    -One of the main clinical signs of proteinuria is foamy urine, which results from excessive protein excretion.

  • How does the decrease in albumin levels in the blood due to nephrotic syndrome affect the body?

    -The decreased level of albumin causes fluid to leave the bloodstream and enter the tissues, potentially leading to ascites, pleural effusion, or swelling of the labia or scrotum.

  • What is the typical pattern of fluid accumulation in the body due to nephrotic syndrome?

    -Fluid typically accumulates in the upper parts of the body, such as the eyelids, during the night. During the day, when a person is sitting or standing, fluid accumulates in the lower parts of the body, such as the ankles.

  • What are some secondary causes of nephrotic syndrome?

    -The most common secondary causes of nephrotic syndrome include diabetes, amyloidosis, lupus, and certain viral infections such as HIV.

  • How does glomerulonephritis, a type of nephritic syndrome, typically present?

    -Glomerulonephritis often occurs as a complication of a throat or skin infection with streptococcus, typically in children between the ages of 2 and 10, some weeks after recovering from the infection.

  • What is the significance of the urinary dipstick in diagnosing nephrotic syndrome?

    -The urinary dipstick measures protein concentration and is often used as a screening test for nephrotic syndrome, although it cannot be used to make the diagnosis on its own.

  • How is nephrotic-range proteinuria defined in a 24-hour urine collection?

    -Nephrotic-range proteinuria is defined as having more than 3.5 g of protein in the urine over a 24-hour collection period.

  • What are some typical laboratory findings for nephrotic syndrome?

    -Typical laboratory findings for nephrotic syndrome include low levels of albumin and a high concentration of lipids, sometimes exceeding 10 times that of a normal concentration.

  • What is the general approach to treating both nephrotic and nephritic syndrome?

    -The first line treatment for both nephrotic and nephritic syndrome is to treat the underlying cause. Additionally, most patients are given diuretics to reduce fluid retention and an ACE inhibitor to lower blood pressure and reduce protein excretion in the urine.

Outlines
00:00
🏥 Understanding Nephrotic and Nephritic Syndromes

This paragraph explains the differences between nephrotic and nephritic syndromes, focusing on their causes and clinical manifestations. Nephrotic syndrome is marked by excessive protein in urine due to increased permeability of the glomerulus, leading to proteinuria and its associated symptoms like foamy urine and edema. It can be primary or secondary, with common causes including focal segmental glomerulosclerosis, membranous nephropathy, minimal change disease, diabetes, and certain infections. Nephritic syndrome involves inflammation of the glomerulus, presenting with edema, low urine volume, and hematuria. Glomerulonephritis, a form of nephritic syndrome, often follows a streptococcus infection and can be diagnosed with urine and blood tests, with renal biopsy providing a definitive diagnosis. Treatment involves addressing the underlying cause and managing symptoms with diuretics and ACE inhibitors.

05:01
🧬 Diagnostics and Treatment of Glomerular Diseases

The second paragraph delves into the diagnostic process and treatment options for glomerular diseases. Urinary protein excretion is a key diagnostic factor, with less than 3 g per day typically seen in glomerulonephritis. The presence of dysmorphic red blood cells, known as acanthocytes, in urine suggests a glomerular cause for hematuria. The urinary dipstick is used as a screening tool for high albumin concentration, but it cannot diagnose nephrotic syndrome. Laboratory findings for nephrotic syndrome include low albumin levels and high lipid concentrations. Additional diagnostic tests like a complete blood cell count, Chest x-ray, echocardiogram, and renal ultrasound may be performed based on the patient's condition. Renal biopsy is crucial for definitive diagnosis in nephritic syndrome and rapidly progressive glomerulonephritis. Treatment primarily targets the underlying cause and includes diuretics, ACE inhibitors, and a diet low in saturated fat, cholesterol, and sodium. Antibiotics are usually ineffective for acute glomerulonephritis, while autoimmune disorders may require corticosteroids or cytotoxic agents.

Mindmap
Keywords
💡Nephrotic Syndrome
Nephrotic syndrome is a kidney disorder characterized by an excessive amount of protein in the urine, which is known as proteinuria. It is caused by an increased permeability of the capillary wall of the glomerulus, allowing too much protein to leak from the blood into the urine. The condition is associated with foamy urine and can lead to low levels of important proteins in the blood, such as albumin, and consequently, fluid retention and swelling in various parts of the body. In the script, it is mentioned as a condition that can be primary or secondary, with examples of causes including focal segmental glomerulosclerosis and diabetes.
💡Nephritic Syndrome
Nephritic syndrome is another kidney disorder, which is distinguished from nephrotic syndrome by the presence of an excess amount of blood in the urine, known as hematuria. It involves inflammation of the glomerulus, or glomerulonephritis, and can be caused by a variety of factors including streptococcus infections, IgA nephropathy, and lupus. The script describes that about half of the people with acute glomerulonephritis have no symptoms, but when present, they include tissue swelling and low urine volume.
💡Glomerulus
The glomerulus is a network of tiny blood vessels (capillaries) located at the beginning of the nephron in the kidney. It plays a crucial role in filtering the blood to create urine. Protein particles in the blood are normally too large to pass through the tiny holes of the glomerulus, but in conditions like nephrotic syndrome, the permeability of the glomerulus is increased, allowing proteins to leak into the urine. The glomerulus is also the site of injury in nephritic syndrome, where inflammation occurs.
💡Proteinuria
Proteinuria refers to the presence of an abnormally high level of protein in the urine, which is a key clinical sign of nephrotic syndrome. The term is used in the script to describe one of the main manifestations of kidney injury, where the permeability of the glomerulus is compromised, leading to the leakage of protein from the blood into the urine, resulting in foamy urine.
💡Albumin
Albumin is a type of protein that is typically not found in the urine due to its size, which prevents it from passing through the glomerulus. However, in nephrotic syndrome, the increased permeability of the glomerulus allows albumin to leak into the urine, leading to low levels of this important protein in the blood. The liver attempts to compensate for this loss by increasing the synthesis of albumin, but this also results in higher levels of cholesterol and triglycerides. Albumin is highlighted in the script as a significant protein whose urinary excretion is a marker for nephrotic syndrome.
💡Fluid Retention
Fluid retention, or edema, is a condition where excess fluid accumulates in the body's tissues. In the context of nephrotic syndrome, the decreased level of albumin in the blood causes fluid to leave the bloodstream and enter the tissues, leading to swelling. The kidneys respond by retaining more water and sodium, which can result in ascites, pleural effusion, or swelling in areas like the labia or scrotum. The script illustrates how fluid retention can vary depending on the body's position, with periorbital edema being a common initial sign.
💡Hematuria
Hematuria is the presence of red blood cells (RBCs) in the urine, which is a characteristic feature of nephritic syndrome. It occurs when the glomerulus becomes inflamed, allowing RBCs to pass through gaps in the glomerulus. The script mentions that hematuria is expected in the urine sediment with red blood cells and proteins, but not to the extent seen in nephrotic syndrome. Hematuria can manifest as tea- or cola-colored urine and is indicative of kidney injury.
💡Glomerulonephritis
Glomerulonephritis is an inflammation of the glomerulus, which is a part of the nephritic syndrome. It can be caused by various factors, including infections, autoimmune disorders, and other diseases. The script explains that glomerulonephritis often occurs as a complication of a throat or skin infection with streptococcus, particularly in children. It can also be a subset of rapidly progressive glomerulonephritis, which presents with severe and progressive renal failure.
💡Renal Function
Renal function refers to how well the kidneys are working to filter waste and excess fluids from the blood to produce urine. The script discusses how nephritic syndrome can lead to a decrease in urine output as the kidneys lose their ability to remove wastes and fluids effectively. This can result in hypertension and is a critical aspect of assessing and managing kidney diseases. Renal function is evaluated through various tests, including the measurement of the glomerular filtration rate (GFR).
💡Renal Biopsy
A renal biopsy is a medical procedure that involves taking a small sample of kidney tissue for examination under a microscope. It is often used in nephritic syndrome for a definitive diagnosis and to distinguish between primary and secondary causes of the disease. The script notes that renal biopsy can provide valuable information regarding the level of inflammation, extent of fibrosis, and overall prognosis of the kidney disease. It is particularly crucial in cases of rapidly progressive glomerulonephritis where prompt diagnosis is necessary.
💡Diuretics
Diuretics are medications that increase the amount of urine produced and excreted, thereby helping to reduce fluid retention in the body. In the context of the script, diuretics are mentioned as part of the first-line treatment for both nephrotic and nephritic syndromes, aiming to alleviate symptoms of edema and lower blood pressure. They are commonly prescribed alongside ACE inhibitors to manage the conditions effectively.
Highlights

Nephrotic syndrome is characterized by an excess amount of protein in the urine, while nephritic syndrome is characterized by an excess amount of blood in the urine.

Normally, no protein passes into the urine when the blood is filtered due to the size of protein particles.

In nephrotic syndrome, increased permeability of the glomerulus allows too much protein to leak from the blood into the urine.

One of the main clinical signs of proteinuria is foamy urine.

Excessive protein excretion in nephrotic syndrome results in low levels of important proteins like albumin in the blood.

The liver compensates for protein loss by increasing albumin synthesis, but also releases more cholesterol and triglycerides.

Decreased albumin levels cause fluid to leave the bloodstream and enter tissues, leading to swelling and potential ascites or pleural effusion.

Fluid causing tissue swelling is affected by gravity and moves around, accumulating in upper body parts at night and lower parts during the day.

Nephritic syndrome involves inflammation of the glomerulus (glomerulonephritis) and can present with tissue swelling, low urine volume, proteinuria and hematuria.

Glomerulonephritis often occurs as a complication of a throat or skin infection with streptococcus, typically in children aged 2-10.

Rapidly progressive glomerulonephritis can present with severe and progressive renal failure, requiring prompt diagnosis and treatment.

Diagnosis of nephrotic and nephritic syndrome is generally made based on urine and blood tests, with a 24-hour urine collection useful for measuring protein loss.

Nephrotic-range proteinuria is defined as having more than 3.5 g of protein in a 24-hour urine collection or a protein/creatinine ratio of 2-3 mg protein per mg creatinine.

Urinary protein excretion varies widely in glomerulonephritis, generally less than 3 g of protein per day.

Microscopic urine examination in glomerulonephritis reveals dysmorphic red blood cells (acanthocytes) indicative of a glomerular cause of hematuria.

A urinary dipstick measures protein concentration, not the rate of excretion, and cannot diagnose nephrotic syndrome but can be used as a screening test.

Typical lab findings in nephrotic syndrome include low albumin levels and high lipid concentrations, while in glomerulonephritis, anemia may suggest impaired EPO production by the kidneys.

Additional useful diagnostic tests depend on the patient's history and physical exam, including chest x-ray, echocardiogram, renal ultrasound, and renal biopsy.

First line treatment for both nephrotic and nephritic syndrome is treating the underlying cause, along with diuretics to reduce fluid retention and ACE inhibitors to lower blood pressure.

General therapy includes a diet low in saturated fat, cholesterol, and sodium. Autoimmune disorders may require treatment with corticosteroids or cytotoxic agents.

Transcripts

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Nephrotic SyndromeNephritic SyndromeKidney DiseaseProteinuriaHematuriaGlomerulonephritisRenal FunctionDiureticsACE InhibitorsAutoimmune DisordersRenal BiopsyHealth EducationMedical Conditions