Which feature is hallmark of nephritic syndrome?

• A. Edema with hypoalbuminemia
• B. Hematuria with RBC casts, oliguria, HTN, mild–moderate proteinuria
• C. Heavy proteinuria (>3.5 g/day) and hypoalbuminemia
• D. Oliguria with proteinuria in the nephrotic range

Answer: (B)

Nephritic syndrome is defined by glomerular inflammation that causes blood in the urine with red blood cell casts, along with reduced kidney function leading to oliguria and hypertension, and only mild to moderate proteinuria. The feature described—hematuria with RBC casts, oliguria, hypertension, and mild–moderate proteinuria—best captures this pattern because RBC casts reflect glomerular bleeding due to inflammation, and the combination of decreased urine output and high blood pressure stems from impaired filtration and salt/water retention. In contrast, heavy proteinuria with hypoalbuminemia and edema points to nephrotic syndrome, not nephritic.