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Nephrotic Syndrome

Hanadi Abou Dargham, MD and Nandhini Veeraraghavan, MD, CAQSM, FAAFP Reviewed 06/2018
 


BASICS

DESCRIPTION

  • A clinical syndrome of proteinuria (>3.5 g/1.73 m2/24 hr), hypoalbuminemia (<3 g/dL), severe hyperlipidemia (total cholesterol often >10 mmol/l) (380 mg/dL), clinical eviden...

DIAGNOSIS

HISTORY

The history is key in pinpointing the cause of nephrotic syndrome. 
  • Inquire about signs or symptoms of systemic disease: joint complaint, rash, edema, infectious complaint, fevers, ano...

TREATMENT

MEDICATION

First Line

  • Edema: salt restriction and salt-wasting diuretics (loop and thiazide diuretics) (2)[A]:

    • Salt restriction to <2 to 3 g sodium per day

    • Restrict fluid intake to <1.5 ...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

  • Frequent monitoring is required for relapse, disease progression, and for detecting signs of toxicity of medical management.

  • Reevaluate for azote...

REFERENCES

1
Kodner C. Nephrotic syndrome in adults: diagnosis and management. Am Fam Physician.  2009;80(10):1129–1134. [View Abstract on OvidMedline]
2
Crew RJ, Radhakrishnan J, Appel G. Complica...

ADDITIONAL READING

Cadnapaphornchai MA, Tkachenko O, Shchekochikhin D, et al. The nephrotic syndrome: pathogenesis and treatment of edema formation and secondary complications. Pediatr Nephrol.  ...

SEE ALSO

Acute Kidney Injury; Amyloidosis; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Glomerulonephritis, Acute; HIV/AIDS; Lupus Erythematosus, Discoid; Multiple Myeloma 

CODES

ICD10

  • N04.9 Nephrotic syndrome with unspecified morphologic changes

  • N04.1 Nephrotic syndrome w focal and segmental glomerular lesions

  • N04.2 Nephrotic syndrome w diffuse membranous glomerulonephriti...

CLINICAL PEARLS

  • Nephrotic syndrome is a clinical syndrome of >3.5 g/day proteinuria, hypoalbuminemia, hyperlipidemia, and edema often associated with diabetes and NSAIDs use.

  • Pediatric nephrotic syn...

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