Nephrotic syndrome: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
*UA | *UA | ||
**Proteinuria, no hematuria | **Proteinuria > 3.5 g/24 hr, no hematuria | ||
**Protein:Cr ratio of > 3 - 3.5 mg/mg (300 - 350 mg/mmol) | |||
*CBC | *CBC | ||
*Chemistry | *Chemistry | ||
**Pseudohyponatremia due to elevated triglycerides | **Pseudohyponatremia due to elevated triglycerides | ||
*Lipid panel | **Serum albumin < 25 g/L | ||
*Lipid panel, with total cholesterol > 380 mg/dL (10 mmol/L) | |||
*ANA, C3, C4, Hep panel | *ANA, C3, C4, Hep panel | ||
*CXR (only if suspect pleural effusion / pulm edema) | *CXR (only if suspect pleural effusion / pulm edema) | ||
Revision as of 12:27, 17 August 2015
Background
- Increased permeability of glomerular capillary wall
- Proteinuria, hypoproteinemia (alb <3), edema, hyperlipidemia
- Life-threatening complications are infection and thromboembolic events
Clinical Features
- Edema (face, periphery)
- SOB, cough (pleural effusion, pulmonary edema)
- Oliguria
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
Diagnosis
- UA
- Proteinuria > 3.5 g/24 hr, no hematuria
- Protein:Cr ratio of > 3 - 3.5 mg/mg (300 - 350 mg/mmol)
- CBC
- Chemistry
- Pseudohyponatremia due to elevated triglycerides
- Serum albumin < 25 g/L
- Lipid panel, with total cholesterol > 380 mg/dL (10 mmol/L)
- ANA, C3, C4, Hep panel
- CXR (only if suspect pleural effusion / pulm edema)
- Ultrasound
- Only if suspect renal vein thrombosis - hematuria, flank pain, ARF
Treatment
- Give IV fluids if evidence of hypovolemic shock (even if edema is severe)
- Volume overload
- Treat with 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 x 6 weeks
- Low-salt diet
Disposition
Admit
- Severe edema
- Pulmonary effusion or respiratory symptoms
- Infection or thrombotic complications
Outpt nephrology follow up
- Mild-moderate edema