Which statement best captures the hallmark features of nephritic syndrome?

• A. Edema and lipiduria.
• B. Hematuria with red cell casts, hypertension, oliguria, variable proteinuria (<3.5 g/day).
• C. Pyuria with bacteria.
• D. Massive proteinuria and hypoalbuminemia.

Answer: (B)

Nephritic syndrome arises from inflammation of the glomeruli that damages the capillary walls, allowing red blood cells to leak into the urine and reducing filtration. The key signs reflect this glomerular origin: hematuria with red cell casts indicates bleeding from the glomerulus, oliguria shows impaired kidney function, and hypertension results from salt and water retention and activation of the renin-angiotensin system. Proteinuria is present but typically modest (often less than nephrotic levels), so you don’t see the heavy protein loss seen in nephrotic syndrome. Edema can occur but is usually milder than in nephrotic cases. In contrast, lipiduria and massive protein loss with hypoalbuminemia point toward nephrotic syndrome, while pyuria with bacteria suggests infection rather than glomerular disease.