At a Glance
Nephrotic syndrome is included in the differential diagnosis of patients with peripheral edema. Nephrotic syndrome is characterized by:
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pitting-edema
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hypoalbuminia
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proteinuria (in adults: ≥3.5 g/24 hours)
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hyperlipidemia (increased cholesterol and/or triglycerides)
What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful?
The clinician should measure serum albumin, 24-hour urine protein excretion, and a fasting lipid profile. It would also be prudent to evaluate renal function overall by performing a urinalysis and measuring creatinine, estimated glomerular filtration rate, and blood urea nitrogen (BUN). (Table 1)
What Lab Results Are Absolutely Confirmatory?
A 24-hour urinary protein excretion is absolutely confirmatory.
What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful?
Urine protein electrophoresis can help identify the type of proteinuria: glomerular, tubular, combined glomerular and tubular, overflow, or non-selective proteinuria.
The differential diagnosis of the nephrotic syndrome is very broad and includes:
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glomerular diseases (e.g., minimal change nephropathy, focal and segmental glomerulosclerosis, and hyalinosis, membranous glomerulopathy, proliferative glomerulonephritis, membranoproliferalite glomerulonephritis (GN), cresentic GN, mesangial proliferative GN, and focal and segmental proliferative glomerulonephritis)
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various secondary disorders (e.g., infectious: acute post-streptococcal glomerulonephritis, infectious mononucleosis; drugs: organic gold, Hg, penicillamine, antivenom, antitoxins, contrast media; neoplasia: Hodgkin disease, lymphomas, leukemias, carcinoma, melanoma, Wilm’s tumor; multisystem diseases: SLE, HSP, vasculitis, Goodpasteur’s syn, dermatomyositis, amyloidosis, sarcoidosis, Sjogren’s syn; hereditary disorders: diabetes mellitus, Alport syndrome, sickle cell disease, Fabry disease, congenital nephrotic syn)
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miscellaneous causes (e.g., preeclamptic toxemia, renovascular hypertension, and chronic interstitial nephritis)
References
Winter, WE, Harris, NS, Winter, WE. “Urine protein electrophoresis”. Multiple Myeloma and Related Serum Protein Disorders: An Electrophoretic Guide. 2012. pp. pp83-116. (Provides an up-to-date review of causes and patterns of proteinuria.)
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