What is Nephrotic and Nephritic Syndrome?
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• Nephrotic Syndrome: Caused by severe damage to the kidney filtration barrier, making the filter "leaky" to protein.
   

  • Massive protein loss in urine, high blood cholesterol/lipids (due to liver's inadvertent production when trying to fix low albumin). Severe, widespread swelling (puffiness around eyes, swollen legs/feet, abdominal swelling/ascites) due to low blood albumin (hypoalbuminemia). Foamy urine (due to heavy protein content).
     

• Nephritic Syndrome: Caused by inflammation and destruction of the glomerulus leading to cells and protein leaking into the urine.
   

  • Blood in the urine (hematuria) = cola-colored or visibly bloody urine; reduced urine output; and high blood pressure (hypertension). Red blood cells and RBC casts in urine, elevated blood urea nitrogen (BUN) and creatinine (signaling reduced kidney clearance). Mild to moderate swelling (mainly around eyes, face, and ankles).

Common Causes of Nephrotic Syndrome
 

• Primary (kidney-specific) Causes:
   

  • Minimal Change Disease: The leading cause of nephrotic syndrome in children; responds well to steroids.

  • Focal Segmental Glomerulosclerosis (FSGS): Scarring in parts of the glomeruli; common in adults.

  • Membranous Nephropathy: Thickening of the glomerular membrane; common in older adults.
     

• Secondary (systemic) causes:
   

  • Diabetic Nephropathy

  • Systemic Lupus Erythematosus (Lupus).

  • Certain viral infections (Hepatitis B/C, HIV).

  • Specific medications or NSAID overuse.

Common Causes of Nephritic Syndrome
 

• Post-Streptococcal Glomerulonephritis (PSGN): Occurs 1 to 3 weeks after a throat (strep throat) or skin (impetigo) bacterial infection, most frequently in children.

• IgA Nephropathy (Berger's Disease): Deposition of IgA antibodies in the kidneys, often triggered by a upper respiratory infection; a common cause of recurrent bloody urine in young adults.

• Lupus Nephritis: Kidney inflammation caused by Systemic Lupus Erythematosus.

• ANCA Vasculitis / Anti-GBM Disease (Goodpasture Syndrome): Autoimmune conditions causing rapid, aggressive inflammation of small blood vessels in the kidneys.

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Diagnostics
 

• Urinalysis w/ microscopy & Urine Protein Measurement — Urinalysis checks for protein, blood, and cellular casts. Urine protein can be quantified using a spot urine protein-to-creatinine ratio, albumin-to-creatinine ratio, or sometimes a 24-hour urine collection.

• Blood Tests: Evaluates kidney function (Creatinine, BUN), serum albumin levels, lipid panel, and specialized autoimmune or antibody markers (e.g., C3/C4 complement levels, ASO titers, ANA, ANCA).

• Kidney Biopsy: May be required in adults (or children with atypical symptoms) to examine kidney tissue under a microscope and pinpoint the exact underlying cause.

Management 
 

• Treatment for Nephrosis:
   

  • Corticosteroids or Other Immunosuppressive Therapy — Used for certain immune-mediated causes of nephrotic syndrome; treatment depends on the underlying kidney disease.

  • ACE Inhibitors / ARBs: Blood pressure medications that reduce blood pressure and reduce protein leakage.

  • Diuretics: To help the body shed excess fluid and relieve severe edema.

  • Fluid and Salt Restriction: To manage hypertension and fluid overload.
     

• Treatment for Nephritis:
   

  • Treating the Underlying Trigger: Antibiotics for active infections, or targeted immunosuppressive therapies (e.g., steroids, cyclophosphamide) for autoimmune cases.

  • Blood Pressure Control

  • Fluid and Salt Restriction: To manage hypertension and fluid overload.

  • Dialysis: Temporarily required in severe, acute cases where kidney clearance drops dangerously low.

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Contact a healthcare provider immediately or go to an emergency room if you or your child experience:
 

• Sudden, rapidly spreading swelling of the face, abdomen, or legs.

• Visible blood in the urine or dark brown/tea-colored urine.

• A dramatic drop in urine volume or producing no urine over several hours.

• Severe headaches, vision changes, or confusion (signs of dangerously high blood pressure).

• Difficulty breathing or shortness of breath (which can indicate fluid accumulation in the lungs).
   

                                                        References & Guidelines
 

• Kidney Disease: Improving Global Outcomes (KDIGO). Clinical Practice Guideline for the Management of Glomerular Diseases.

• KDIGO. Clinical Practice Guideline for Nephrotic Syndrome in Children.

• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Nephrotic Syndrome in Adults.

• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Glomerular Disease.

• KDIGO. Clinical Practice Guidelines for IgA Nephropathy, ANCA-Associated Vasculitis, and Lupus Nephritis.

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