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Nephritic vs Nephrotic Syndrome

Step 1: If the patient has hematuria and/or proteinuria, think about nephrotic/nephritic syndromes.
Step
hematuria (RBC casts ... dysmorphic RBCs in urine ... #Syndrome #Comparison ... #Algorithm #Nephrology ... #Diagnosis
Glomerular Diseases - Nephritic and Nephrotic Syndromes

Nephritic syndrome—due to GBM disruption. 
Hypertension. t BUN and creatinine.
RBC casts in urine ... but in severe cases ... #Classification ... #Proteinuria #Nephrology ... #Diagnosis
Differentiation Between Nephrotic Syndrome and Nephritic Syndrome 
== Nephrotic Syndrome ==
Onset - Insidious 
Edema - ++++
Blood
Red blood cell casts ... Red blood cell casts ... edgarvlermamd - Nephrology ... #Comparison #Table ... #Nephrology #Diagnosis
Atlas of Urine Microscopy Findings
 • Epithelial cells - Normal
 • Renal tubular cells - Acute
microscopy • Red cell casts ... • White cell casts ... infection • Hyaline casts ... disease • Granular casts ... #nephrology #casts
Hematuria Workup and Diagnosis Algorithm
 • Confirm hematuria → Urinalysis >3 RBCs/HPF, exclude mimics, repeat testing
Hematuria Workup and Diagnosis ... • Evidence of glomerular ... proteinuria, RBC casts ... → Refer to Nephrology ... cystoscopy • Refer to Nephrology
Urinary Casts and Disease Associations
Hyaline - May be nonspecific; seen in normal individuals or during severe
Urinary Casts and ... breakdown of cellular casts ... heme-granular casts ... edgarvlermamd - Nephrology ... #Nephrology
Urine Microscopy - Casts
Acellular Casts
 • Hyaline Casts - Consists of only precipitated Tamm-Horsfell protein without
Urine Microscopy ... suggestive of nephrotic ... #Urine #Microscopy ... #nephrology #interpretation ... #diagnosis
Hematuria - Differential Diagnosis Framework

Gross Hematuria: Red/Dark urine
 • 1ml blood/liter urine can induce color change
- Differential Diagnosis ... hematuria: - RBC casts ... → Diagnostic of ... #causes #urology ... #nephrology #renal
Causes of Proteinuria - Differential Diagnosis Algorithm
Persistent Proteinuria >150mg/d protein present on repeat testing including overnight
- Differential Diagnosis ... • Drugs Glomerular ... sediment - WBC/RBC casts ... #Proteinuria #Nephrology ... #Algorithm #Causes
Algorithm - Approach to the differential diagnosis of the patient presenting with overt glomerular proteinuria. CMV
cell/white cell casts ... urine sediment ... Nephrocalcinosis causes ... #nephrotic #syndrome ... #nephrology