Overview
Introduction
Nephrotic syndrome is a clinical pattern caused by injury to the glomerular filtration barrier.
Nephrotic syndrome is a clinical pattern caused by injury to the glomerular filtration barrier. Albumin and other plasma proteins escape into the urine in large quantities, producing the combination of heavy proteinuria, low serum albumin, oedema, and hyperlipidaemia. The defining thresholds are protein excretion of at least 3.5 g in 24 hours or a urine protein-to-creatinine ratio of at least 200 mg/mmol, with serum albumin below 25 g/L. The visible problem is swelling; the less visible problems are reduced effective circulating volume, thrombosis, infection, and acute kidney injury. A patient can have marked peripheral oedema and still be intravascularly depleted. That apparent contradiction determines whether the next action is cautious volume support, further diuresis, or urgent escalation.