The Bottom Line: Many underlying systemic conditions can cause nephrotic syndrome (NS), although type 2 diabetes mellitus and systemic lupus erythematosus are most common. NS may not present as a primary diagnosis, but instead as one of multiple disease manifestations, particularly in systemic lupus erythematosus.
References: Hull RP. “Nephrotic syndrome in adults.” BMJ. 2008 May 24; 336(7654):1185-1189. doi:10.1136/bmj.39576.709711.80.
Kodner C. “Diagnosis and management of nephrotic syndrome in adults.” American Family Physician. 2016 Mar 15;93(6):479-485.
Summary: Key points as outlined by Hull (2008):
Nephrotic syndrome is a relatively rare but important manifestation of kidney disease.
It has serious complications and must be on the differential diagnosis for any patient presenting with new onset oedema.
It can be caused by a wide range of primary (idiopathic) and secondary glomerular diseases.
All patients should be referred to a nephrologist for further investigation, which (often) includes a renal biopsy.
Initial management should focus on investigating the cause, identifying complications, and managing the symptoms of the disease.
Secondary causes of NS include metabolic, immunologic, idiopathic/primary, neoplastic, medication/drug use, bacterial infection, protozoan infection, viral infection, allergic, genetic syndromes, and other. For the complete listing, see Table 1 in Kodner’s 2016 article.