++
++
Proteinuria > 3 g/d
Hypoalbuminemia (serum albumin < 3.5 g/dL)
Peripheral edema
Hyperlipidemia
Oval fat bodies may be seen in the urine
Most common cause is diabetes; other causes include
++
++
Urinalysis: proteinuria; few cellular elements or casts
Serum albumin < 3 g/dL, serum protein < 6 g/dL
Hyperlipidemia occurs in > 50% of patients with nephrotic syndrome and worsens with the severity of the nephrotic syndrome
Elevated erythrocyte sedimentation rate
Deficiencies of vitamin D, zinc, and copper if heavy urinary excretion of binding proteins
The following tests may help elucidate the underlying cause of glomerular disease
Complement levels
Serum and urine protein electrophoresis and immunofixations
Serum free light chains
Antinuclear antibodies
Phospholipase A2 receptor (PLA2R) antibody titers
HbA1c
Serologic testing for hepatitis B and C, HIV, and syphilis
Kidney biopsy indicated in adults with new-onset idiopathic nephrotic syndrome if a primary renal disease is suspected that may require immunosuppressive therapy
++
In those with isolated proteinuria, dietary protein restriction may be helpful in slowing progression of kidney disease
Anti-proteinuric therapy slows progression of kidney disease for patients with and without diabetes
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin receptor blockers (ARB)
Mineralocorticoid receptor antagonists
Sodium-glucose cotransporter-2 (SGLT2) inhibitors
Can be used in patients with reduced GFR if, after initiation of therapy or after dose titration,
Significant hyperkalemia (potassium > 5.5 mEq/L) does not occur
Serum creatinine rises < 30%
Patients are counseled on preventive practices to avoid acute kidney injury and hyperkalemia
Combination ARB and ACE inhibitor therapy is not recommended
Magnetic resonance angiography is not recommended when eGFR is less than 30 mL/min
++
++
+++
Hypercoagulable state
++
In patients with thrombosis, warfarin for at least 3–6 months
Indefinite anticoagulation may be required for