Nephrotic syndrome: Difference between revisions
m (Rossdonaldson1 moved page Nephrotic Syndrome to Nephrotic syndrome) |
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**Only if suspect renal vein thrombosis - hematuria, flank pain, ARF | **Only if suspect renal vein thrombosis - hematuria, flank pain, ARF | ||
== | ==Differential Diagnosis== | ||
*Primary nephrotic syndrome | *Primary nephrotic syndrome | ||
**Minimal-change, Membranoproliferative | **Minimal-change, Membranoproliferative | ||
*Secondary nephrotic syndrome | *Secondary nephrotic syndrome | ||
**SLE, HSP, SCD | **SLE, HSP, SCD | ||
{{Periorbital swelling DDX}} | |||
==Treatment== | ==Treatment== |
Revision as of 05:54, 13 August 2015
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
Differential Diagnosis
- Primary nephrotic syndrome
- Minimal-change, Membranoproliferative
- Secondary nephrotic syndrome
- SLE, HSP, SCD
Periorbital swelling
Proptosis
- Normal IOP
- Orbital cellulitis
- Orbital pseudotumor
- Orbital tumor
- Increased IOP
- Retrobulbar abscess
- Retrobulbar emphysema
- Retrobulbar hemorrhage
- Ocular compartment syndrome
- Orbital tumor
No proptosis
- Periorbital cellulitis/erysipelas
- Dacryocystitis (lacrimal duct)
- Dacryocele/Dacryocystocele
- Dacryostenosis
- Dacryoadenitis (lacrimal gland)
- Allergic reaction
- Nephrotic Syndrome (pediatrics)
Lid Complications
- Blepharitis (crusts)
- Chalazion (meibomian gland)
- Stye (hordeolum) (eyelash folicle)
Other
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Conjunctivitis
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Sarcoidosis
- Granulomatosis with polyangiitis
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