Nephritic vs Nephrotic Syndrome: Step 1 review notes and self-test
Notes for the Nephritic vs Nephrotic Syndrome rapid review: the clue that separates each of its 5 confusion pairs, with timestamps and a self-test.
October 21, 2026
This video covers the clues that separate nephritic and nephrotic syndromes and their major glomerular diseases. Watch the video, then use these notes to test yourself.
Nephritic syndrome vs Nephrotic syndrome
Blood, RBC casts, hypertension, and oliguria point you toward nephritic syndrome, while heavy protein, hypoalbuminemia, and lipiduria point you toward nephrotic syndrome. Do not use edema alone because it can mislead you. When you see edema, decide whether the urine is dominated by blood and casts or by heavy protein and lipid.
Nephritic syndrome vs Nephrotic syndrome Blood/RBC casts and hypertension point nephritic; massive protein and lipiduria point nephrotic. Open the comparison and video →IgA nephropathy vs Poststreptococcal GN
Hematuria during or within days of an upper respiratory infection with normal C3 points you toward IgA nephropathy, while hematuria one to three weeks after a strep infection with low C3 points you toward poststreptococcal GN. Both can follow a sore throat, so timing is the trap. Use timing and complement together to separate synpharyngitic IgA nephropathy from delayed poststreptococcal GN.
IgA nephropathy vs Poststreptococcal GN IgA nephropathy: hematuria during the infection with normal C3; PSGN: hematuria 1 to 3 weeks after infection with low C3. Open the comparison and video →Minimal change disease vs FSGS
A child with nephrotic syndrome, normal light microscopy, selective albuminuria, and steroid responsiveness points you toward minimal change disease, while segmental sclerosis with lower steroid responsiveness points you toward FSGS. Both can cause heavy proteinuria, hypoalbuminemia, and diffuse foot process effacement, so electron microscopy alone does not separate them. Use the clinical setting and light microscopy findings to decide between them.
Minimal change disease vs FSGS Minimal change is steroid-responsive child with normal LM; FSGS is segmental sclerosis and often resistant. Open the comparison and video →Membranous nephropathy vs Membranoproliferative GN
Subepithelial spike-and-dome deposits with a nephrotic picture point you toward membranous nephropathy, while subendothelial and mesangial deposits with tram-track splitting and a mixed nephritic-nephrotic picture point you toward membranoproliferative GN. Both names contain membrane and both are immune-complex glomerulonephritides, so the biopsy phrase is the key. Normal complement supports membranous nephropathy, while low complement supports membranoproliferative GN.
Membranous nephropathy vs Membranoproliferative GN Membranous is subepithelial spike-and-dome nephrotic disease; MPGN is subendothelial/mesangial tram-track mixed disease. Open the comparison and video →Proliferative lupus nephritis vs Membranous / sclerosing lupus nephritis
Classes III and IV are proliferative nephritic disease, Class V is membranous nephrotic disease, and Class VI is advanced sclerosing disease with chronic irreversible damage. Proteinuria can occur in several classes, so it does not separate them by itself. Translate the biopsy word as focal, diffuse, membranous, or sclerosing before you match the physiology.
Proliferative lupus nephritis vs Membranous / sclerosing lupus nephritis Classes III/IV are proliferative nephritic activity; Class V is membranous nephrotic disease; Class VI is advanced sclerosis. Open the comparison and video →Quick self-test
Name the diagnosis from the clue, then tap to check.
Child with nephrotic syndrome, normal light microscopy, selective albuminuria, and steroid responsiveness.
Minimal change disease · Minimal change disease vs FSGS
Adult nephrotic syndrome with diffuse capillary wall thickening and spike-and-dome deposits.
Membranous nephropathy · Membranous nephropathy vs Membranoproliferative GN
Heavy proteinuria, hypoalbuminemia, edema, hyperlipidemia, and oval fat bodies.
Nephrotic syndrome · Nephritic syndrome vs Nephrotic syndrome
Gross hematuria during or within days of an upper respiratory infection.
IgA nephropathy · IgA nephropathy vs Poststreptococcal GN
Nephritic syndrome one to three weeks after strep infection with low complement.
Poststreptococcal GN · IgA nephropathy vs Poststreptococcal GN
Mixed nephritic-nephrotic picture with subendothelial/mesangial deposits and tram-track basement membrane splitting.
Membranoproliferative GN · Membranous nephropathy vs Membranoproliferative GN
Hematuria with RBC casts, hypertension, oliguria, and usually subnephrotic proteinuria under 3.5 g/day.
Nephritic syndrome · Nephritic syndrome vs Nephrotic syndrome
Nephrotic syndrome with segmental sclerosis, often linked to HIV collapsing nephropathy, heroin use, obesity, or high-risk ancestry.
Keep going
Every pair in this review has a free page in the library with a side-by-side comparison and a practice question. Work through the ones you missed in the self-test first.