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| |bgcolor="#ececec"|'''Malignancy''' || | | |bgcolor="#ececec"|'''Malignancy''' || |
| *Weight loss, fever, fatigue | | *Weight loss, fever, fatigue |
| *Pitting or non-pitting edema, ascites, pleural effusion, pulmonary edema | | *Pitting or non-pitting edema with serous exudation, ascites, pleural effusion, pulmonary edema |
| *Lymphatic obstruction | | *Lymphatic obstruction |
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| *Stasis dermatitis | | *Stasis dermatitis |
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| <center><sup>Adapted from Hull RP, Goldsmith DJ. Nephrotic syndrome in adults. BMJ. 2008; 336:1185-9</sup></center>
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| * '''[[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
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| * '''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
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| * '''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]].
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| * '''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.
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| ==References== | | ==References== |
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
|
| Malignancy |
- Weight loss, fever, fatigue
- Pitting or non-pitting edema with serous exudation, ascites, pleural effusion, pulmonary edema
- Lymphatic obstruction
|
| Lymphedema |
- History of lymph node resection and/or radiation therapy, especially in breast cancer
- Fatigue
- Swollen limb with localized fluid accumulation
- Skin discoloration
|
| Venous Insufficiency |
- Painful extremities
- Bluish Skin discoloration
- Edema mostly after prolonged standing
- Stasis dermatitis
|
References
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