How to Diagnose Nephrotic Syndrome

Nephrotic Syndrome refers to a series of clinical symptoms presenting as large amount of proteinuria, hyperlipemia, severe swelling and hypoproteinemia. Continuous and severe proteinuria will lead to hypoalbuminemia, swelling and finally develops into Nephrotic Syndrome.

From the pathogeny of Nephrotic Syndrome, it can be divided into Primary Nephrotic Syndrome and Secondary Nephrotic Syndrome. Primary Nephrotic Syndrome is a series of symptoms caused by Primary Glomerular Nephropathy, Acute Glomerulonephritis, Progressive Glomerulonephritis and Chronic Glomerulonephritis. While secondary Nephrotic Syndrome is caused by the diseases of organs except kidneys or systemic disorders which mainly are infections, connective tissue diseases, metabolic diseases, tumors and hypersensitivity diseases.

How can we know we get Nephrotic Syndrome from its symptoms? Clinically, the characteristics of Nephrotic Syndrome are:

Large amount of Proteinuria (>3.5g/24hours),

Severe swelling

Hyperlipidemia

Hypoproteinemia (low levels of plasma albumins in blood (<3g/dl))

However, if large amount of proteinuria and hypoalbuminemia occur, we can say that Nephrotic Syndrome develops.

(1) Sodium,water retention and swelling: swelling is always the early symptom of Nephrotic Syndrome which develops insidiously. The main reasons of swelling are hypoalbuminemia, retention of water and sodium, massive hormones and so on.

In the early stage, light swelling only appears in eyes, feet, hands and face. While in the late stage, severe swelling will appear in the whole body. At this time, symptoms such as chest tightness, short of breath, difficulty in breath and even congestive heart failure will appear.

(2) Proteinuria, hypoalbuminemia and malnutrition: large amount of proteinuria will cause the reduction of plasma albumins and proteinuria is a necessary condition to diagnose Nephrotic Syndrome. Proteins in the urine mainly come from plasma, which are mainly: myosin and immunoglobulin.

(3) Hyperliporoteinemia: the lipid metabolism of patients with Nephrotic Syndrome is characterized by the increase of low density lipoprotein (LDL)and very low density lipoprotein (VLDL), making the increase of cholesterol and triglyceride in the blood. As a result, arteriosclerosis will appear in patients with Nephotic Syndrome.

(4) Hypercoagulable state: the hypercoagulabe state leads to intravascular thrombosis and the deposition of most fibrin in the glomeruli, deteriorating the function of kidneys.

(5) Infection: the loss of immune globulin, metabolic disorder, the application of immunosuppressive of patients with Nephrotic Syndrome will cause the decline of their immunity. At this time, the patients are extremely easy to be infected and the respiratory tract infection, urinary tract infection and primary peritonitis are the most common to be seen.

(6)Renal insufficiency: various pathological types of Nephrotic Syndrome can cause renal insufficiency. At the stage of severe swelling and significantly active period of pathological changes, Nephrotic Syndrome is always accompanied with transient renal insufficiency which will be back to normal when the swelling vanishes. However, if patients with Nephrotic Syndrome caused by Chronic Glomerulonephritis, most of their kidney functions can not recover even the swelling vanishes.

In conclusion, how to identify Nephrotic Syndrome?


It is not difficult to diagnose Nephrotic Syndrome according to the medical history and classical manifestations in clinic. The main points are: (1) plasma albumin≤3g/dl and total proteins<6g. (2) 24 Urinary albumen≥3.5g. (3) Hyperlipidemia. (4) Swelling. As long as the first two appear, the Nephrotic Syndrome is identified. Patients should have further etiological diagnosis after the Nephrotic Syndrome is identified. So, if one’s Nephrotic Syndrome is identified, the earlier to receive treatment, the better.