Nephrotic Syndrome

Today, we discussed a case of an elderly man with HTN and alcohol use disorder who presented with subacute progressive dyspnea, weight gain, and decreased UOP in setting of NSAID use, found to have nephrotic syndrome secondary to minimal change disease.  Some learning points on nephrotic syndrome:

1) Can be contrasted with nephritic syndrome. Keeping in mind that nephrotic syndrome is defined by protein excretion greater than 3 grams/day--associated with edema, hypoalbuminemia, hyperlipidemia, and lipiduria.

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2) Complications include:

  • Volume overload
  • CV disease (related to HLD)
  • Thromboembolism! (related to generation of prothrombotic factors and loss of anticoagulant factors via proteinuria)
  • Endocrine abnormalities
  • Infection
  • Anemia
  • Acute Renal Failure (common and often due to ATN from severe intravascular volume depletion)

3) Etiology can be primary or systemic diseases:

  • Primary:
    • Focal segmental glomerulosclerosis
    • Membranous nephropathy
    • Minimal change disease--Prototypical presentation includes acute onset of nephrotic syndrome following URI in a patient with atopy.  Defined by podocyte effacement (on electron microscopy), can be secondary to drugs (NSAIDS, ampicillin, IFN, lithium, rifampin), thymoma,
    • Membranoproliferative glomerulonephritis
    • IgA nephropathy
  • Secondary:
    • Diabetic nephropathy
    • Systemic lupus erythematosus
    • Myeloma kidney
    • Amyloidosis
    • Toxins such as NSAIDs

4) Bonus question:  Be the first to answer correctly and win a starbucks gift card. 

At what albumin level would you consider starting prophylactic anticoagulation in patients with nephrotic syndrome?