Nephrotic syndrome differential diagnosis: Difference between revisions
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==Differentiating Nephrotic Syndrome from other Diseases== | ==Differentiating Nephrotic Syndrome from other Diseases== | ||
The differential diagnosis of nephrotic syndrome includes other disease with similar findings on physical examination, such as lower extremity edema, or similar clinical findings, such as hypoalbuminemia | |||
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|+ '''''Common Differential Diagnoses of Nephrotic Syndrome<ref name="pmid19904897">{{cite journal|author=Kodner C| title=Nephrotic syndrome in adults: diagnosis and management. | journal=Am Fam Physician | year= 2009 | volume= 80 | issue= 10 | pages= 1129-34 |pmid=19904897 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19904897 }} </ref><ref name="pmid18497417">{{cite journal| author=Hull RP, Goldsmith DJ| title=Nephrotic syndrome in adults.| journal=BMJ | year= 2008 | volume= 336 | issue= 7654 | pages= 1185-9 | pmid=18497417 |doi=10.1136/bmj.39576.709711.80 | pmc=PMC2394708 |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18497417 }} </ref>''''' | |||
| bgcolor="#d9ff54"|'''Differential Diagnosis''' || bgcolor="#d9ff54"|'''Characteristic Features''' | |||
|- | |||
| bgcolor="#ececec"|'''Congestive Heart Failure''' || | |||
*History of cardiovascular disease | |||
*Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, pitting edema, pulmonary edema | |||
*Low ejection fraction on echocardiography | |||
*Elevated brain natriuretic peptide (BNP) levels | |||
*Abnormal heart rate | |||
*Third heart sound | |||
*Lung crackles or wheezing | |||
*Elevated jugular venous pressure | |||
*Cardiomegaly with cardiothoracic ratio on xray > 0.5 | |||
|- | |||
| bgcolor="#ececec"|'''Liver Cirrhosis''' || | |||
*Gynecomastia, spider angiomata, testicular atrophy, encephalopathy | |||
*Pitting edema and ascites | |||
*Normal/elevated liver transaminases | |||
*Prolonged INR | |||
*Hypoalbuminemia | |||
*Shrunken liver on imaging | |||
|- | |||
| bgcolor="#ececec"|'''Protein Losing Enteropathy''' || | |||
|} | |||
<center><sup>Adapted from Hull RP, Goldsmith DJ. Nephrotic syndrome in adults. BMJ. 2008; 336:1185-9</sup></center> | |||
* '''[[Heart failure]]''': The patient is older, with a history of heart disease. [[Jugular venous pressure]] is elevated on examination, might hear heart [[murmur]]s. An [[echocardiogram]] is the gold standard investigation | * '''[[Heart failure]]''': The patient is older, with a history of heart disease. [[Jugular venous pressure]] is elevated on examination, might hear heart [[murmur]]s. An [[echocardiogram]] is the gold standard investigation | ||
Revision as of 23:00, 16 November 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Differentiating Nephrotic Syndrome from other Diseases
The differential diagnosis of nephrotic syndrome includes other disease with similar findings on physical examination, such as lower extremity edema, or similar clinical findings, such as hypoalbuminemia
| Differential Diagnosis | Characteristic Features |
| Congestive Heart Failure |
|
| Liver Cirrhosis |
|
| Protein Losing Enteropathy |
- Heart failure: The patient is older, with a history of heart disease. Jugular venous pressure is elevated on examination, might hear heart murmurs. An echocardiogram is the gold standard investigation
- Liver failure: History suggestive of hepatitis/ cirrhosis: alcoholic, IV drug user, some hereditary causes. Stigmata of liver disease are seen: dilated veins over umbilicus (caput medusae), scratch marks, enlarged spleen, spider angiomata, encephalopathy, bruising, nodular liver
- Acute fluid overload in someone with kidney failure: These people are known to have kidney failure, and have either drunk too much or missed their dialysis.
- Metastatic cancer: When cancer seeds the lungs or abdomen it causes effusions and fluid accumulation due to obstruction of lymphatics and veins as well as serous exudation.
References
- ↑ Kodner C (2009). "Nephrotic syndrome in adults: diagnosis and management". Am Fam Physician. 80 (10): 1129–34. PMID 19904897.
- ↑ Hull RP, Goldsmith DJ (2008). "Nephrotic syndrome in adults". BMJ. 336 (7654): 1185–9. doi:10.1136/bmj.39576.709711.80. PMC 2394708. PMID 18497417.