Which finding is more typical of nephritic syndrome than nephrotic syndrome?

• A. Hematuria with RBC casts
• B. Massive proteinuria with hypoalbuminemia
• C. Hypoalbuminemia without edema
• D. Hyperlipidemia

Answer: (C)

Nephritic syndrome is driven by inflammation of the glomeruli, which compromises the filtration barrier enough to let red blood cells leak into the urine. This produces visible hematuria and often red blood cell casts in the urine sediment. Proteinuria is present but typically not massive, and patients may have hypertension and some decline in kidney function. In contrast, nephrotic syndrome features a much more permeable barrier that allows large amounts of protein to pass into urine, leading to massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Hypoalbuminemia without edema isn’t typical of nephritic syndrome because edema is a hallmark of nephrotic changes, and hyperlipidemia is characteristic of nephrotic rather than nephritic changes. Therefore, hematuria with red blood cell casts is the finding that best aligns with nephritic syndrome.