Nephrotic Syndrome - Signs and Symptoms

Signs and Symptoms

It is characterized by proteinuria (>3.5g/day), hypoalbuminemia, hyperlipidemia, and edema (which is generalized and also known as anasarca or dropsy). It is common among 2 – 6 years old boys. The edema begins in the face. Lipiduria (lipids in urine) can also occur, but is not essential for the diagnosis of nephrotic syndrome. Hyponatremia also occurs with a low fractional sodium excretion.

Hyperlipidemia is caused by two factors:

• Hypoproteinemia stimulates protein synthesis in the liver, resulting in the overproduction of lipoproteins.
• Lipid catabolism is decreased due to lower levels of lipoprotein lipase, the main enzyme involved in lipoprotein breakdown.

A few other characteristics seen in nephrotic syndrome are:

• The most common sign is excess fluid in the body due to the serum hypoalbuminemia. Lower serum oncotic pressure causes fluid to accumulate in the interstitial tissues. Sodium and water retention aggravate the edema. This may take several forms:
  • Puffiness around the eyes, characteristically in the morning.
  • Pitting edema over the legs.
  • Fluid in the pleural cavity causing pleural effusion. More commonly associated with excess fluid is pulmonary edema.
  • Fluid in the peritoneal cavity causing ascites.
  • Generalized edema throughout the body known as anasarca.
• Most of the patients are normotensive but hypertension (rarely) may also occur.
• Anemia (iron resistant microcytic hypochromic type) maybe present due to transferrin loss.
• Dyspnea may be present due to pleural effusion or due to diaphragmatic compression with ascites.
• Erythrocyte sedimentation rate is increased due to increased fibrinogen & other plasma contents.
• Some patients may notice foamy or frothy urine, due to a lowering of the surface tension by the severe proteinuria. Actual urinary complaints such as hematuria or oliguria are uncommon, though these are seen commonly in nephritic syndrome.
• May have features of the underlying cause, such as the rash associated with systemic lupus erythematosus, or the neuropathy associated with diabetes.
• Examination should also exclude other causes of gross edema—especially the cardiovascular and hepatic system.
• Muehrcke's nails; white lines (leukonychia) that extend all the way across the nail and lie parallel to the lunula