Nephrotic syndrome

Last revised by Daniel J Bell on 12 Dec 2022

Nephrotic syndrome results from loss of plasma proteins in the urine and characterized by hypoalbuminemia, hyperalbuminuria, hyperlipidemia, and edema. It may be caused by primary (idiopathic) renal disease or by a variety of secondary causes.

Patients present with marked edema, proteinuria, hypoalbuminemia, and often hyperlipidemia 1.

It may be classified as congenital or acquired 1:

Nephrotic syndrome per se may produce non-specific appearances due to marked edema and hypoalbuminemia, e.g. anasarca, bowel wall thickening, etc. Chyluria may be seen due to the heavy losses of chyle/fats in the urine.

Treatment of most patients should include fluid and sodium restriction, oral or intravenous diuretics, and angiotensin-converting enzyme inhibitors 1,4-6. Some adults with nephrotic syndrome may benefit from corticosteroid treatment, cyclosporine A, although research data are limited 1,4-6. Intravenous albumin, prophylactic antibiotics, and prophylactic anticoagulation are not currently recommended 1,4-6

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Cases and figures

  • Case 1: complicated by bone infarct
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