At a Glance
Nephrotic syndrome is included in the differential diagnosis of patients with peripheral edema. Nephrotic syndrome is characterized by:
proteinuria (in adults: ≥3.5 g/24 hours)
hyperlipidemia (increased cholesterol and/or triglycerides)
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.
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:
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)
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)
miscellaneous causes (e.g., preeclamptic toxemia, renovascular hypertension, and chronic interstitial nephritis)
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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