Which statement BEST describes nephritic syndrome?

• A. Nephritic syndrome features heavy proteinuria with hypoalbuminemia, edema, and hyperlipidemia
• B. Nephritic syndrome features glomerular inflammation with hematuria and RBC casts, with mild–moderate proteinuria
• C. Nephritic syndrome features hypertensive azotemia with heavy proteinuria
• D. Nephritic syndrome features no proteinuria and no hematuria

Answer: (B)

Nephritic syndrome is defined by glomerular inflammation that causes bleeding into the urine and impaired filtration, leading to hematuria with red blood cell casts and only modest protein loss. The best choice describes glomerular inflammation with hematuria and red blood cell casts in the urine, plus mild to moderate proteinuria. The red blood cell casts specifically indicate a glomerular source of bleeding, which is a hallmark of nephritic processes, and the proteinuria is present but not as heavy as in nephrotic syndrome. In nephrotic syndrome you’d expect heavy proteinuria with hypoalbuminemia, edema, and hyperlipidemia, which is not the pattern here. Conversely, no proteinuria and no hematuria would not fit nephritic syndrome.