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Nephritic vs Nephrotic Syndrome

Step 1: If the patient has hematuria and/or proteinuria, think about nephrotic/nephritic syndromes.
Step
the patient has hematuria ... (RBC casts or 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.
hematuria. ... RBC casts in urine ... but in severe cases ... #Proteinuria #Nephrology ... #Diagnosis
Differentiation Between Nephrotic Syndrome and Nephritic Syndrome 
== Nephrotic Syndrome ==
Onset - Insidious 
Edema - ++++
Blood
Proteinuria - ++++ Hematuria ... Red blood cell casts ... Proteinuria - ++ Hematuria ... Red blood cell casts ... #Diagnosis
Hematuria Workup and Diagnosis Algorithm
 • Confirm hematuria → Urinalysis >3 RBCs/HPF, exclude mimics, repeat testing
and Diagnosis Algorithm ... proteinuria, RBC casts ... → Refer to Nephrology ... for renal biopsy ... #Diagnosis #Algorithm
Hematuria - Differential Diagnosis Framework

Gross Hematuria: Red/Dark urine
 • 1ml blood/liter urine can induce color change
Diagnosis Framework ... : - RBC casts ... → Diagnostic of ... Causes of Hematuria ... #nephrology #renal
Causes of Hematuria - Differential Diagnosis Algorithm
Red blood cells on urine microscopy. Must exclude false positives
Causes of Hematuria ... Algorithm Red ... blood cells on urine ... RBCs and/or RBC casts ... #Algorithm #Causes
Algorithmic Approach to Acute Interstitial Nephritis
When to suspect AIN? (not sensitive)
 • AKI, AKD, rapidly progressive
Algorithmic Approach ... sterile pyuria, WBC casts ... eosinophiluria, microscopic hematuria ... proteinuria, granular casts ... #nephrology #diagnosis
Atlas of Urine Microscopy Findings
 • Epithelial cells - Normal
 • Renal tubular cells - Acute
microscopy • Red cell casts ... • White cell casts ... • Hyaline casts ... disease • Granular casts ... #nephrology #casts
Urinary Casts and Disease Associations
Hyaline - May be nonspecific; seen in normal individuals or during severe
Urinary Casts and ... and concentrated urine ... breakdown of cellular casts ... heme-granular casts ... 34t5DgJ #Urinary #Casts
Causes of Hematuria - Differential Diagnosis
Renal:
 - Glomerular - IgA Nephropathy, Thin basement membrane, Alport syndrome,
Causes of Hematuria ... Renal: - Glomerular ... - Interstitial nephritis ... - Structural - Cysts ... #Diagnosis #Causes