Nephrotic syndrome differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, Serge Korjian

Overview

The differential diagnosis of nephrotic syndrome includes other diseases with similar findings on physical examination, such as lower extremity edema, or similar clinical findings, such as hypoalbuminemia. Differential diagnoses include congestive heart failure, liver cirrhosis, protein losing enteropathy, malignancy, lymphedema, venous insufficiency, and malnutrition.

Differential Diagnosis

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 Syphilis can present as proteinuria, edema, weight gain, fatigue and dyspnea. 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 X-ray > 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
Malnutrition	Weight loss, fatigue, irritability, dyspnea, and depression Menstrual irregularities Poor wound healing and easy bruisibility Muscle atrophy and fat wasting Dry skin and hair loss Anemia Hypoalbuminemia