Evaluation of nephrotic syndrome

In general, the evaluation of nephrotic syndrome should be done promptly, but it is not a medical emergency. Assessment can generally be accomplished as an outpatient (including renal biopsy, which is typically a daycase procedure, unless complicated by blood pressure or coagulation issues).

Rapidly progressive glomerulonephritis, requiring hospital admission and prompt evaluation, should be suspected if the patient presents with rapid deterioration of renal function.

Patients with a severe nephrotic syndrome may require a hospital admission for intravenous diuresis, especially if there is an accompanying acute kidney injury.

The major complications of the nephrotic syndrome include:[59]Park SJ, Shin JI. Complications of nephrotic syndrome. Korean J Pediatr. 2011 Aug;54(8):322-8. https://e-cep.org/journal/view.php?doi=10.3345/kjp.2011.54.8.322 http://www.ncbi.nlm.nih.gov/pubmed/22087198?tool=bestpractice.com [60]Hilmanto D, Mawardi F, Lestari AS, et al. Disease-associated systemic complications in childhood nephrotic syndrome: a systematic review. Int J Nephrol Renovasc Dis. 2022 Feb 25:15:53-62. https://www.dovepress.com/disease-associated-systemic-complications-in-childhood-nephrotic-syndr-peer-reviewed-fulltext-article-IJNRD http://www.ncbi.nlm.nih.gov/pubmed/35241925?tool=bestpractice.com [61]Stabouli S, Chrysaidou K, Kupferman JC, et al. Neurological complications in childhood nephrotic syndrome: a systematic review. Eur J Paediatr Neurol. 2019 May;23(3):384-91. http://www.ncbi.nlm.nih.gov/pubmed/30837193?tool=bestpractice.com

• Proteinuria and edema, which can become generalized (anasarca)

• Protein malnutrition, with a negative nitrogen balance due to marked proteinuria

• Hypovolemia due to over-diuresis, particularly in the presence of hypoalbuminemia

• Acute kidney injury secondary to hypovolemia, ischemic injury, nonsteroidal anti-inflammatory drugs

• Hyperlipidemia and accelerated atherosclerosis

• Hypercoagulability causing arterial plus venous thrombosis. Renal vein thrombosis is disproportionately more common with membranous nephropathy, but it can occur in any patient with severe proteinuria and hypoalbuminemia, especially those in recumbency

• Immunocompromised state and infections

• Rapidly progressive glomerulonephritis, especially if in the context of hematuria, proteinuria, severe or malignant hypertension, and peripheral edema.