Nephrotic Syndrome II : Assessment and Medical Management

Proteinuria in nephrotic syndrome is defined as daily protein excretion exceeding 3.5 grams, primarily from albumin loss. Diagnosis is confirmed through a 24-hour urine collection, which normally shows protein excretion under 150 mg/day. This significant protein loss in the urine is the primary diagnostic indicator of nephrotic syndrome.

Urine tests detect proteinuria through 24-hour collection and spot protein-to-creatinine ratios. Urine protein electrophoresis and immunofixation categorize proteinuria types and identify specific renal pathologies. Urine microscopy may reveal white blood cells, granular casts, or epithelial casts, indicating renal inflammation and helping confirm the diagnosis.

Blood tests typically show serum albumin levels below 3.5 g/dL due to protein loss, and elevated lipid profiles reflecting secondary hyperlipidemia. Creatinine and blood urea nitrogen may be elevated if renal impairment is present. Electrolyte imbalances, particularly reduced sodium or potassium levels, are also common findings.

A kidney biopsy provides histological evidence confirming nephrotic syndrome diagnosis and underlying pathology. It is typically performed when the underlying cause is unclear or primary glomerular disease is suspected. The biopsy helps identify specific renal pathologies guiding targeted treatment decisions.

Loop diuretics like furosemide reduce edema caused by fluid retention. ACE inhibitors such as enalapril lower protein leakage and manage hypertension by reducing glomerular filtration pressure. Statins address hyperlipidemia by managing elevated lipid levels associated with nephrotic syndrome and improving patient outcomes.

Moderate protein intake is advised to prevent worsening proteinuria, while sodium restriction to approximately 2 grams daily helps decrease fluid retention and manage blood pressure. In severe edema cases, fluid restriction may be recommended. Regular weight monitoring and adherence to a low-sodium, low-fat diet support overall health management.

Generalized edema, particularly in the face, hands, and legs, is a hallmark finding. Hypertension is commonly observed due to fluid retention. Foamy urine often indicates proteinuria, while patients may report fatigue, loss of appetite, and abdominal pain from fluid accumulation and low blood protein levels.