Nephrotic syndrome: Difference between revisions
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* Edema progressing to anasarca |
* Edema progressing to anasarca |
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* May have frothy urine |
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* Fatigue, anorexia |
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* May develop DVT/PE |
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* Found to have proteinuria, hyperlipidemia, and hypoalbuminemia on investigations |
* Found to have proteinuria, hyperlipidemia, and hypoalbuminemia on investigations |
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** Often also have hypocalcemia |
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== Investigations == |
== Investigations == |
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* For diagnosis: urine protein, lipid panel, albumin levels |
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* Urine protein |
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* For secondary causes: send HBV, HCV, HIV, syphilis, HbA1c, ANA, SPEP/UPEP, cryoglobulins, RF, CH50, C3, C4 |
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* Lipid panel |
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* Often needs kidney biopsy |
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* Albumin levels |
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* May need imaging for DVT or PE |
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== Diagnosis == |
== Diagnosis == |
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* Definition of the syndrome: |
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* Significant proteinuria > 3g/day |
** Significant proteinuria > 3g/day |
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* Hyperlipidemia/lipiduria |
** Hyperlipidemia/lipiduria |
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* Anasarca |
** Anasarca |
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* Hypoalbuminemia <35g/L |
** Hypoalbuminemia <35g/L |
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* Diagnosis of the underlying cause often requires renal biopsy |
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== Management == |
== Management == |
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Latest revision as of 16:07, 2 March 2026
Background
- Clinical syndrome characterized by massive proteinuria, which results in hypoalbuminema, hyperlipidemia, and edema
- Can be primary (idiopathic) or secondary
Etiologies
Common
- Membranous nephropathy (24%)
- Minimal change disease (16%)
- Systemic lupus erythematosus (14%)
- FSGS (12%): more common in black patients
- Amyloidosis (6 to 17%): more common in older patients
- Membranoproliferative glomerulonephritis (7%)
- IgA nephropathy (6%)
Exhaustive
- Non-proliferative glomerulonephritis
- Minimal change disease
- Primary
- Drugs
- NSAIDs and COX-2 inhibitors
- Ampicillin, rifampicin, cephalosporins
- Lithium
- D-penicillamine and tiopronin
- Pamidronate
- Sulfasalazine and 5-ASA
- Interferon-gamma
- Neosplasms
- Lupus nephritis V (membranous nephritis)
- Focal segmental glomerulosclerosis
- Primary
- Severe obesity and other hyperfiltration syndromes
- Infections: HIV, parvovirus B19, CMV, EBV
- Drugs
- Heroin
- Interferons
- Pamidronate
- Anabolic steroids
- mTOR inhibitors
- Calcineurin inhibitors
- Anthracyclines
- Lithium
- Other
- Sickle cell anemia
- Thrombotic microangiopathy
- Genetic disorders
- Membranous nephropathy
- Primary
- Systemic lupus erythematosus
- Drugs: gold, penicillamine, NSAIDs
- Infections: hepatitis B and hepatitis C, malaria, syphilis
- Neoplasms
- Non-Hodgkin lymphoma
- Solid cancers
- IgG4 disease
- Minimal change disease
Epidemiology
- If < 20 years old
- Minimal change (70%)
- Membranous (20%)
- Focal segmental glomerulosclerosis (10%)
- If > 20 years old
- Membranous (70%)
- Minimal change (20%)
- Focal segmental glomerulosclerosis (10%)
Clinical Manifestations
- Edema progressing to anasarca
- May have frothy urine
- Fatigue, anorexia
- May develop DVT/PE
- Found to have proteinuria, hyperlipidemia, and hypoalbuminemia on investigations
- Often also have hypocalcemia
Investigations
- For diagnosis: urine protein, lipid panel, albumin levels
- For secondary causes: send HBV, HCV, HIV, syphilis, HbA1c, ANA, SPEP/UPEP, cryoglobulins, RF, CH50, C3, C4
- Often needs kidney biopsy
- May need imaging for DVT or PE
Diagnosis
- Definition of the syndrome:
- Significant proteinuria > 3g/day
- Hyperlipidemia/lipiduria
- Anasarca
- Hypoalbuminemia <35g/L
- Diagnosis of the underlying cause often requires renal biopsy
Management
- If < 20 years old
- Treat empirically with steroids, as the majority are primary minimal change disease
- If > 20 years old
- Needs kidney biopsy to direct treatment
