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Nephrotic and Nephritic Syndromes
Nephrotic and Nephritic Syndromes
Syndromes
13/7/14
glomerular
disease:
Silly picture
A
presentation:
DDx:
nephritic
nephrotic
ABCD
CDEF
Nephritic syndrome
-itic like -itis means inflammation, so think of a
glomerulus damaged by inflammation.
Such a glomerulus will be leaking
inappropriately, i.e.:
1. Leaking things it shouldnt be (blood)
2. Not leaking things it should be (GFR).
?minor proteinuria
hematuria with RBC casts
GFR
?minor proteinuria
hematuria with RBC casts
GFR
plasma creatinine
and urea
(uremia)
oliguria
?minor proteinuria
hematuria with RBC casts
GFR
plasma creatinine
and urea
(uremia)
oliguria
Na+ retention
?minor proteinuria
hematuria with RBC casts
GFR
plasma creatinine
and urea
(uremia)
oliguria
Na+ retention
?minor proteinuria
hematuria with RBC casts
GFR
Na+ retention
water retention
plasma creatinine
and urea
(uremia)
plasma volume
oliguria
?minor proteinuria
hematuria with RBC casts
GFR
Na+ retention
water retention
plasma creatinine
and urea
(uremia)
plasma volume
oliguria
?edema
hypertension
JVP, cardiomegaly
?minor proteinuria
hematuria with RBC casts
GFR
Na+ retention
water retention
plasma creatinine
and urea
(uremia)
plasma volume
oliguria
?edema
hypertension
JVP, cardiomegaly
Nephrotic syndrome
The glomerulus is damaged but not inflamed,
so it leaks things it shouldnt, but otherwise filters
normally.
The damage is more subtle than nephritic, so
proteins can leak, but not usually blood.
Symptoms are all consequences of this protein
loss.
protein filtration
glomerular damage
without inflammation
(preserves GFR but makes
glomerulus leaky to protein)
protein filtration
glomerular damage
without inflammation
(preserves GFR but makes
glomerulus leaky to protein)
hypoalbuminemia
?anemia
(loss of transferrin)
proteinuria
protein filtration
glomerular damage
without inflammation
(preserves GFR but makes
glomerulus leaky to protein)
Filtered proteases
cleave inactive
ENaC in late DT
hypoalbuminemia
?anemia
(loss of transferrin)
proteinuria
Na+ retention
protein filtration
glomerular damage
without inflammation
(preserves GFR but makes
glomerulus leaky to protein)
Filtered proteases
cleave inactive
ENaC in late DT
hypoalbuminemia
?anemia
(loss of transferrin)
proteinuria
Na+ retention
protein filtration
glomerular damage
without inflammation
(preserves GFR but makes
glomerulus leaky to protein)
Filtered proteases
cleave inactive
ENaC in late DT
hypoalbuminemia
?anemia
(loss of transferrin)
proteinuria
Na+ retention
water retention
plasma volume
protein filtration
glomerular damage
without inflammation
(preserves GFR but makes
glomerulus leaky to protein)
Filtered proteases
cleave inactive
ENaC in late DT
hypoalbuminemia
?anemia
(loss of transferrin)
proteinuria
Na+ retention
water retention
plasma volume
plasma oncotic
pressure
edema
protein filtration
glomerular damage
without inflammation
(preserves GFR but makes
glomerulus leaky to protein)
Filtered proteases
cleave inactive
ENaC in late DT
hypoalbuminemia
?anemia
(loss of transferrin)
proteinuria
Na+ retention
water retention
plasma volume
plasma oncotic
pressure
edema
protein filtration
glomerular damage
without inflammation
(preserves GFR but makes
glomerulus leaky to protein)
Filtered proteases
cleave inactive
ENaC in late DT
hypoalbuminemia
?anemia
(loss of transferrin)
plasma LDL
(hyperlipidemia)
proteinuria
Na+ retention
water retention
plasma volume
plasma oncotic
pressure
edema
protein filtration
glomerular damage
without inflammation
(preserves GFR but makes
glomerulus leaky to protein)
Filtered proteases
cleave inactive
ENaC in late DT
hypoalbuminemia
?anemia
(loss of transferrin)
plasma LDL
(hyperlipidemia)
proteinuria
Na+ retention
water retention
plasma volume
plasma oncotic
pressure
edema
Nephrotic
Non-inflammatory causes
Hematuria
Hypertension
Oliguria
+Maybe edema and mild
proteinuria
Hypoalbuminemia
Edema
Lipids
Proteinuria
Nephrotic