The nephrotic syndrome may present with the following symptoms and signs:
- periorbital, genital and/or dependent oedema
- usual presenting feature is oedema which is generalized and affected by gravity
- face, particularly the periorbital area, is swollen in the morning, the lower limbs and genital area later in the day as extracellular fluid accumulates and develops in the dependent areas
- transudative ascites - especially in children (1)
- pleural effusions may occur
- abdominal discomfort - which may be associated with hypovolaemia, ascites or peritonitis
- diarrhoea and/or vomiting
- presenteation in a child
- often upper respiratory tract infection and, with onset of oedema, children will be lethargic, irritable and have poor appetite, and may have diarrhoea and abdominal pain (2)
Other possible features include:
- exacerbation of existing cardiac disease
- breathlessness due to abdominal distension or exacerbation of existing cardiac disease
- infection due to loss of IgG and complement components into the urine
- may be a hypercoagulable state
- hypovolaemia and acute renal failure
- signs and symptoms of an underlying cause such as SLE
- in children blood pressure is usually normal or low. Persistent hypertension is rare in MCD or FSGS and should raise suspicion of some other form of glomerular disease such as membranoproliferative disease (2)
It is important to exclude primary cardiac failure, with a raised JVP, pulmonary oedema and mild proteinuria and liver disease and other causes of hypoalbuminaemia.
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