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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 ... have glomerular hematuria ... (RBC casts or dysmorphic ... RBCs in urine)? ... Comparison #Algorithm #Nephrology
Glomerular Diseases - Nephritic and Nephrotic Syndromes

Nephritic syndrome—due to GBM disruption. 
Hypertension. t BUN and creatinine.
hematuria. ... RBC casts in urine ... severe cases ... may be in nephrotic ... #Proteinuria #Nephrology
Differentiation Between Nephrotic Syndrome and Nephritic Syndrome 
== Nephrotic Syndrome ==
Onset - Insidious 
Edema - ++++
Blood
Proteinuria - ++++ Hematuria ... cell casts - Absent ... cell casts - Present ... edgarvlermamd - Nephrology ... Comparison #Table #Nephrology
Hematuria Workup and Diagnosis Algorithm
 • Confirm hematuria → Urinalysis >3 RBCs/HPF, exclude mimics, repeat testing
(proteinuria, RBC ... casts, dysmorphic ... → Refer to Nephrology ... to Nephrology if ... #blood #urine
Hematuria - Differential Diagnosis Framework

Gross Hematuria: Red/Dark urine
 • 1ml blood/liter urine can induce color change
Hematuria - Differential ... • Signs of glomerular ... RBC casts → Diagnostic ... #urology #nephrology ... blood
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 ... Microscopy #Diagnosis #Nephrology
Urine Microscopy - Casts
Acellular Casts
 • Hyaline Casts - Consists of only precipitated Tamm-Horsfell protein without
Urine Microscopy ... suggestive of nephrotic ... • RBC Casts - ... #Urine #Microscopy ... #nephrology #interpretation
Causes of Hematuria - Differential Diagnosis Algorithm
Red blood cells on urine microscopy. Must exclude false positives
Causes of Hematuria ... - Differential ... Algorithm Red blood ... cells on urine ... casts) - Isolated
Algorithmic Approach to Acute Interstitial Nephritis
When to suspect AIN? (not sensitive)
 • AKI, AKD, rapidly progressive
sterile pyuria, WBC ... casts, eosinophiluria ... , microscopic hematuria ... proteinuria, granular casts ... #nephrology #diagnosis
Causes of Proteinuria - Differential Diagnosis Algorithm
Persistent Proteinuria >150mg/d protein present on repeat testing including overnight
Causes of Proteinuria ... - Differential ... RBC casts ... #Proteinuria #Nephrology ... #Differential #