Chapter 24-17: Nephrotic Syndrome

TEXTBOOK PRESENTATION

See Chapter 17-9: Nephrotic Syndrome, Edema for full discussion. Patients typically complain of edema.

DISEASE HIGHLIGHTS

1. Lesions may be primary and idiopathic (eg, minimal change lesion) or secondary to systemic disease (eg, diabetes mellitus, malignancy).

2. Glomerular lesions lead to albuminuria and hypoalbuminemia.

   1. Hypoalbuminemia decreases oncotic pressures decreasing effective circulating volume.

   2. Decreased effective circulating volume triggers sodium retention (which may be aggravated by kidney failure).

   3. The combination of sodium retention and hypoalbuminemia cause edema and hypervolemia.

   4. The ineffective circulating volume can also trigger ADH release, reduce free water clearance, and promote hyponatremia.

   5. Pseudohyponatremia may also be seen secondary to marked hypertriglyceridemia.

EVIDENCE-BASED DIAGNOSIS

1. Nephrotic syndrome is characterized by urine protein excretion ≥ 3.5 g/day, edema, hypoalbuminemia, and hyperlipidemia.

2. Renal biopsy can help identify certain underlying disease states.

TREATMENT

1. Free water restriction.

2. Vaptans may be effective in patients with a GFR > 50 mL/min who do not respond adequately to water restriction (see Table 24-6).