Nephrotic syndrome differential diagnosis

Nephrotic Syndrome Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Nephrotic syndrome from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X-Ray
Echocardiography or Ultrasound
CT Scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Nephrotic syndrome differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Nephrotic syndrome differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Nephrotic syndrome differential diagnosis
CDC on Nephrotic syndrome differential diagnosis
Nephrotic syndrome differential diagnosis in the news
Blogs on Nephrotic syndrome differential diagnosis
Directions to Hospitals Treating Nephrotic syndrome
Risk calculators and risk factors for Nephrotic syndrome differential diagnosis

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

Common Differential Diagnoses of Nephrotic Syndrome

Differential Diagnosis	Characteristic Features
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
Liver Cirrhosis	Gynecomastia, spider angiomata, testicular atrophy, encephalopathy Pitting edema and ascites Normal/elevated liver transaminases Prolonged INR Hypoalbuminemia Shrunken liver on imaging
Protein Losing Enteropathy	Watery diarrhea Abdominal pain Weight loss Hypoalbuminemia and hypoglobulinemia Stool alpha-1-antitrypsin Imaging and endoscopy findings depend on etiology of enteropathy

^{Adapted from Hull RP, Goldsmith DJ. Nephrotic syndrome in adults. BMJ. 2008; 336:1185-9}

• 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.