💧 Nephrotic Syndrome vs Glomerulonephritis
One leaks protein, the other leaks blood. Two childhood kidney diseases that look similar and are opposites.
⚖️ The comparison
NephrOtic leaks prOtein. NephrItic leaks blood and causes hypertensIon.
| NEPHROTIC syndrome | ACUTE GLOMERULONEPHRITIS | |
|---|---|---|
| Urine | Massive protein, frothy | Blood — tea or cola colored |
| Edema | Severe, generalized; periorbital on waking, ascites | Mild, periorbital |
| Blood pressure | Normal or low | HIGH |
| Serum albumin | LOW | Normal |
| Cholesterol | High | Normal |
| Preceded by | Often idiopathic | Strep infection 1–3 weeks earlier — throat or skin |
| Age | 2–7 years | 5–12 years |
| Treatment | Steroids, albumin, low salt | Supportive; BP control, fluid limits |
The giveaway history: a child who had a sore throat or impetigo a couple of weeks ago and now has cola-colored urine and high blood pressure has post-streptococcal glomerulonephritis.
Confirmed by raised ASO titre and low complement (C3).
🩺 Nursing care
✅ Daily weight is the assessment
Same time, same scale, same clothing. In nephrotic syndrome it tracks the edema and the response to steroids better than anything else.
Also measure abdominal girth for ascites, and strict input and output.
Nephrotic syndrome
- Steroids are the mainstay — expect the child to become puffy-faced, hungry and moody
- Low salt while edematous; normal protein (not high — extra protein worsens the leak)
- Infection is the major risk — they lose immunoglobulins in the urine and are on steroids. Watch for peritonitis and cellulitis
- Skin care — edematous skin breaks down easily; support the scrotum, change position
- Test urine for protein daily
Steroids must be tapered, never stopped abruptly. And a child on steroids may not mount a fever with infection - any lethargy or abdominal pain needs review.
Glomerulonephritis
- Monitor blood pressure closely — hypertension is the dangerous feature
- Fluid and sodium restriction while edematous and hypertensive
- Bed rest during the acute phase
- Antibiotics if streptococcal infection is still present
- Most children recover fully — important reassurance for parents
The complication to watch for is hypertensive encephalopathy - headache, visual changes, seizures. Report a rising blood pressure promptly.
💩 Pediatric UTI — the other one to know
Infants present non-specifically: fever, poor feeding, vomiting, irritability — not dysuria. A febrile infant with no obvious source needs a urine sample.
Teaching: wipe front to back, cotton underwear, avoid bubble baths, empty the bladder fully and often, plenty of fluids.
Recurrent UTIs prompt investigation for vesicoureteral reflux, because repeated pyelonephritis scars the kidney permanently.
🎯 NCLEX traps
- Protein + massive edema + normal BP = nephrotic
- Blood + high BP + recent strep = glomerulonephritis
- Daily weight is the key assessment in both
- Nephrotic children are at high risk of infection
- Do not give a high-protein diet in nephrotic syndrome
- Febrile infant with no source → check the urine