Nephrotic Syndrome

Epidemiology

  • Prevalence: 21% of cases have a pleural effusion

Etiology

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Physiology

  • Decreased plasma oncotic pressure with transudation of fluid

Diagnosis

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Clinical

Renal Manifestations

Systemic Manifestations

  • Edema

Hematologic Manifestations

Pulmonary Manifestations

  • Pleural Effusion (see Pleural Effusion-Transudate, [[Pleural Effusion-Transudate]])
    • Epidemiology: present in 21% of nephrotic syndrome cases
    • Diagnosis
      • CXR/Chest CT
        • Usually bilateral
        • Frequently subpulmonic
        • Presence of unilateral or asymmetric effusion should raise suspicion for acute PE or infection (in one series of cases with nephrotic syndrome and effusion, 22% of patients had acute PE)
      • V/Q Scan: may be necessary to rule out acute PE (since effusion can be transudative or less commonly, exudative in acute PE)
      • Thoracentesis: usually required to rule out acute PE, etc

Treatment

  • Treatment to increase plasma oncotic pressure and decrease proteinuria:
  • Therapeutic thoracenteses: not indicated (since protein depletion may occur)
  • Pleurodesis: may be required in some cases with persistent symptomatic effusion despite aggressive therapy of nephrotic syndrome

References

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