Nephrotic and Nephritic Syndrome

A patient with new periorbital edema, frothy urine, and a recent weight gain may have a nephrotic pattern. Another patient with cola-colored urine, severe hypertension, oliguria, and a rising creatinine has a nephritic pattern. Both involve the glomerulus, but the immediate risks and diagnostic direction differ. These are syndromes, not single diseases. Lupus nephritis, IgA nephropathy, membranous nephropathy, and other glomerular disorders can produce nephrotic, nephritic, or mixed findings. The bedside task is to identify the dominant pattern, determine whether kidney function is deteriorating, and escalate the findings that suggest rapidly progressive disease.