Nephrotic syndrome

Background

• Increased permeability of glomerular capillary wall
  • Proteinuria, hypoproteinemia (alb <3), edema, hyperlipidemia
• Life-threatening complications are infection and thromboembolic events

Diagnosis

• Edema (face, periphery)
• SOB, cough (pleural effusion, pulmonary edema)
• Oliguria

Work-Up

• UA
  • Proteinuria, no hematuria
• CBC
• Chemistry
  • Pseudohyponatremia due to elevated triglycerides
• Lipid panel
• ANA, C3, C4, Hep panel
• CXR (only if suspect pleural effusion / pulm edema)
• Ultrasound
  • Only if suspect renal vein thrombosis - hematuria, flank pain, ARF

DDx

• Primary nephrotic syndrome
  • Minimal-change, Membranoproliferative
• Secondary nephrotic syndrome
  • SLE, HSP, SCD

Treatment

• Give IV fluids if e/o hypovolemic shock (even if edema is severe)
• Volume overload
  • Treat w/ furosemide 1-2mg/kg
  • May require correction of hypoalbuminemia first; 0.5-1gm/kg
• Steroids
  • Effective for minimal-change disease
  • Prednisone 2mg/kg/d in 2-3 divided doses x6wk
• Low-salt diet

Disposition

Admit:

• Severe edema
• Pulmonary effusion or respiratory symptoms
• Infection or thrombotic complications

Outpt nephrology f/u:

• Mild-moderate edema

Source

Tintinalli