Nephrotic syndrome physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Physical Examination

A full physical examination is always indicated in patients presenting with nephrotic syndrome. Findings on physical examination suggestive of secondary etiologies may be present, such as characteristic rash in systemic lupus erythematosus (SLE), or peripheral neuropathy in diabetes mellitus.

In primary nephrotic syndrome, the following findings are generally present.

Vital Signs

• High blood pressure, more common in adults

Skin

• May have features of underlying cause, such as rash associated with SLE

Eyes

• Periorbital edema

Lungs

• Pulmonary fine crackles, suggestive of transudative pulmonary edema
• Faint pulmonary auscultation, suggestive of pleural effusion
• Decreased tactile fremitus
• Dull percussion

Abdomen

• Abdominal distension
• Shifting dullness, suggestive of ascites
• Dull percussion

Extremities

• Pitting edema in lower extremities bilaterally