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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
Glomerular Diseases - Nephritic and Nephrotic Syndromes

Nephritic syndrome—due to GBM disruption. 
Hypertension. t BUN and creatinine.
RBC casts in urine ... 3.5 g/day) but in ... severe cases ... may be in nephrotic ... #Proteinuria #Nephrology
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
Acute Kidney Injury (AKI) - Common Patterns on Urinalysis
 - Prerenal
 - ATN
 - AIN
 -
Acute Kidney Injury ... - AIN - UTI ... - Nephrotic Syndrome ... Urinalysis #diagnosis #table ... #comparison #nephrology
Urine Microscopy - Casts
Acellular Casts
 • Hyaline Casts - Consists of only precipitated Tamm-Horsfell protein without
Urine Microscopy ... suggestive of acute ... a variety of acute ... suggestive of nephrotic ... #nephrology #interpretation
Algorithmic Approach to Acute Interstitial Nephritis
When to suspect AIN? (not sensitive)
 • AKI, AKD, rapidly progressive
Nephritis When ... sterile pyuria, WBC casts ... proteinuria, granular casts ... #AIN #Algorithm ... #nephrology #diagnosis
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 ... are seen in acute ... 34t5DgJ #Urinary #Casts
Atlas of Urine Microscopy Findings
 • Epithelial cells - Normal
 • Renal tubular cells - Acute
• White cell casts ... infection • Hyaline casts ... disease • Granular casts ... key #diagnosis #nephrology ... #casts
Simplified Approach to Acute Kidney Injury (AKI)
1) IS THIS AN EMERGENCY? 
Is there a dialysis indication
Simplified Approach to Acute ... Urinary obstruction, Nephrotoxic ... PROBLEM ~80% of AKI cases ... IMPROVEMENT If the urine ... for WBCs, RBCs, casts
Hematuria Workup and Diagnosis Algorithm
 • Confirm hematuria → Urinalysis >3 RBCs/HPF, exclude mimics, repeat testing
and Diagnosis Algorithm ... repeat testing • Acute ... unilateral flank pain ... proteinuria, RBC casts ... → Refer to Nephrology