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Cardiology769 papers

Nephrotic syndrome

Last edited: 4/23/2026

Overview

Nephrotic syndrome is characterized by heavy proteinuria, hypoalbuminemia, hyperlipidemia, and edema, often resulting from glomerular capillary wall abnormalities. It significantly impacts pediatric and adult populations, necessitating comprehensive management strategies to mitigate complications 11031.

Diagnosis

  • Key Diagnostic Criteria: Heavy proteinuria (>3-4 g/day), hypoalbuminemia (<3 g/dL), hypercholesterolemia, edema, and often microscopic hematuria 110.
  • Recommended Tests: Urinalysis, 24-hour urine protein measurement, serum albumin, lipid profile, renal biopsy for definitive diagnosis 11031.
  • Grading: Nephrotic syndrome is typically classified based on etiology (idiopathic, secondary) and responsiveness to steroids 424.
  • Management

  • First-Line Treatments:
  • - Steroids: Prednisone for steroid-sensitive nephrotic syndrome (SSNS) 424. - Immunosuppressants: Cyclophosphamide, vincristine, or calcineurin inhibitors for steroid-resistant nephrotic syndrome (SRNS) 622.
  • Adjunctive Treatments:
  • - Lipid Management: Statins to control hyperlipidemia 333. - Anticoagulation: Prophylactic anticoagulation for VTE risk, considering DOACs over warfarin 2137. - Diuretics: Furosemide for edema management; tolvaptan for refractory edema 3334.
  • Monitoring: Regular assessment of proteinuria, renal function, and coagulation status 121.
  • Special Populations

  • Pediatrics:
  • - SSNS: Early response to steroids; long-term follow-up for recurrence 424. - SRNS: Consider genetic testing and targeted therapies like rituximab 6948.
  • Comorbidities:
  • - Thromboembolic Risk: Increased vigilance and prophylactic anticoagulation in high-risk patients 2137. - Infections: Enhanced infection monitoring due to immunosuppression 5758.

    Key Recommendations

  • Initiate Steroids for SSNS: Prednisone is recommended as first-line therapy for steroid-sensitive nephrotic syndrome (Evidence: Strong 4).
  • Consider Genetic Testing in SRNS: Evaluate genetic causes in steroid-resistant nephrotic syndrome to guide targeted therapies (Evidence: Moderate 69).
  • Prophylactic Anticoagulation for VTE Risk: Implement prophylactic anticoagulation in patients with high risk of venous thromboembolism, favoring DOACs over warfarin (Evidence: Moderate 2137).
  • Regular Monitoring of Proteinuria and Renal Function: Essential for managing disease progression and treatment efficacy (Evidence: Expert opinion 1).
  • Lipid Management with Statins: Use statins to manage hypercholesterolemia associated with nephrotic syndrome (Evidence: Moderate 3).
  • References

    Showing 100 most recent of 325 indexed papers.

    1 Nada A, Ahmed Y, Hu J, Weidemann D, Gorman GH, Lecea EG et al.. AI-powered insights in pediatric nephrology: current applications and future opportunities. Pediatric nephrology (Berlin, Germany) 2026. link 2 Shinkawa K, Yoshida S, Nakao YM, Hayashi A, Sakoda K, Yanagita M et al.. Epidemiology of rehabilitation practices for inpatients with nephrotic syndrome: a retrospective cohort study using an administrative database. Clinical and experimental nephrology 2026. link 3 Waller AP, Wolfgang KJ, Stevenson ZS, Holle LA, Wolberg AS, Kerlin BA. Hypoalbuminemia increases fibrin clot density and impairs fibrinolysis. Journal of thrombosis and haemostasis : JTH 2026. link 4 Floege J, Gibson KL, Vivarelli M, Liew A, Radhakrishnan J, Balk EM et al.. Executive summary of the KDIGO 2025 Clinical Practice Guideline for the Management of Nephrotic Syndrome in Children. Kidney international 2025. link 5 Lanktree MB, Shurrab S, Ejaz R, McNiven V, Brick L, Selvathesan N et al.. Educating the Next-Generation Expert in Nephrology Genetics. Seminars in nephrology 2025. link 6 Daga A, Oh GJ, Traum AZ. A national survey of pediatric nephrologists on the treatment of steroid-resistant nephrotic syndrome. Clinical nephrology 2025. link 7 Mondillo G, Frattolillo V, Colosimo S, Perrotta A, Di Sessa A, Guarino S et al.. Basal knowledge in the field of pediatric nephrology and its enhancement following specific training of ChatGPT-4 "omni" and Gemini 1.5 Flash. Pediatric nephrology (Berlin, Germany) 2025. link 8 Sav NM. Assessing the performance of large language models (GPT-3.5 and GPT-4) and accurate clinical information for pediatric nephrology. Pediatric nephrology (Berlin, Germany) 2025. link 9 Fernandez HE, Lipton M, Balderes O, Lin F, Marasa M, Milo Rasouly H et al.. Pediatric nephrologists' perspectives and clinical practices related to genetic testing and education. Pediatric nephrology (Berlin, Germany) 2025. link 10 Chan EY, Boyer O. Childhood idiopathic nephrotic syndrome: recent advancements shaping future guidelines. Pediatric nephrology (Berlin, Germany) 2025. link 11 Niel O, Dookhun D, Caliment A. Performance evaluation of large language models in pediatric nephrology clinical decision support: a comprehensive assessment. Pediatric nephrology (Berlin, Germany) 2025. link 12 Sharma AP, Medeiros M, Norozi S, Guzmán-Núñez APM, Filler G. Clinical applicability of 2023 International Pediatric Nephrology Association recommended limited therapeutic drug monitoring formulae to assess mycophenolic acid exposure. Pediatric nephrology (Berlin, Germany) 2025. link 13 Ye J, Huang J, Shao L, Wang Z. Immune checkpoint inhibitor-induced nephrotic syndrome: a pharmacovigilance analysis of 404 FAERS cases and literature case series. Renal failure 2025. link 14 Masago S, Yamaoka K, Uchida M, Uesawa Y, Yorifuji K, Shimizu T. Comprehensive Analysis of Proteinuria and Nephrotic Syndrome Using the Japanese Adverse Drug Event Reporting Database. In vivo (Athens, Greece) 2025. link 15 Robinson C, Wagner S, Aman N, Banh THM, Dhillon V, Langlois V et al.. Incidence and Risk Factors for Hypertension among Children with Nephrotic Syndrome. The Journal of pediatrics 2025. link 16 Taira S, Nishihira M, Oba K, Narayama K, Yamauchi A. Aortic valve thrombosis in nephrotic syndrome: a case report. Journal of nephrology 2025. link 17 Liu S, Wan Y, Hu Z, Wang Z, Liu F. Nephrotic syndrome associated with solid malignancies: a systematic review. BMC nephrology 2024. link 18 Dev V, Mittal A, Joshi V, Meena JK, Dhanesh Goel A, Didel S et al.. Cost analysis of telemedicine use in paediatric nephrology-the LMIC perspective. Pediatric nephrology (Berlin, Germany) 2024. link 19 Ünal A, Leventoğlu E, Bakkaloğlu SA. Rituximab use in paediatric nephrology practice in Türkiye: TRTX. Nephrology (Carlton, Vic.) 2024. link 20 Sethi SK, Mahan J, Hu J, Koratala A, Soni K, Singh Y et al.. Point-of-Care Ultrasound (POCUS) Training Curriculum for Pediatric Nephrology: PCRRT-ICONIC Group Recommendations. Kidney360 2024. link 21 De Pascali F, Brunini F, Rombolà G, Squizzato A. Efficacy and safety of prophylactic anticoagulation in patients with primary nephrotic syndrome: a systematic review and meta-analysis. Internal medicine journal 2024. link 22 Takemasa Y, Fujinaga S, Nakagawa M, Sakuraya K, Hirano D. Adult survivors of childhood-onset steroid-dependent and steroid-resistant nephrotic syndrome treated with cyclosporine: a long-term single-center experience. Pediatric nephrology (Berlin, Germany) 2024. link 23 Starr MC, Voivodas M, Hains DS. Using aquapheresis with continuous hematocrit monitoring to guide ultrafiltration. Pediatric nephrology (Berlin, Germany) 2024. link 24 Trautmann A, Boyer O, Hodson E, Bagga A, Gipson DS, Samuel S et al.. IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome. Pediatric nephrology (Berlin, Germany) 2023. link 25 Primack WA, Chevalier RL, Friedman A, Lemley KV, Norwood VF, Schwartz GJ et al.. The first randomized controlled trial in pediatric nephrology: the history of the International Study of Kidney Disease in Children (ISKDC). Pediatric nephrology (Berlin, Germany) 2023. link 26 Wang Z, Tang HY, Lin Q, Li XZ. Incidence of thromboembolism in children with primary nephrotic syndrome: a systematic review and metaanalysis. BMC nephrology 2023. link 27 Aquilani R, Verri M. Nutrition for Podocyte Repair in Nephrotic Syndrome?. Nutrients 2023. link 28 Gür Güven A. History of Pediatric Nephrology in Türkiye. Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation 2023. link 29 Varnell CD, Margolis P, Goebel J, Hooper DK. The learning health system for pediatric nephrology: building better systems to improve health. Pediatric nephrology (Berlin, Germany) 2023. link 30 Beadell I, Quinlan C. A decision-making framework for genomic testing in paediatric nephrology. Journal of paediatrics and child health 2023. link 31 Ambarsari CG, Utami DAP, Tandri CC, Satari HI. Comparison of three spot proteinuria measurements for pediatric nephrotic syndrome: based on the International pediatric Nephrology Association 2022 Guidelines. Renal failure 2023. link 32 Filler G, Gipson DS, Iyamuremye D, Díaz González de Ferris ME. Artificial Intelligence in Pediatric Nephrology-A Call for Action. Advances in kidney disease and health 2023. link 33 Mariani LH, Eddy S, AlAkwaa FM, McCown PJ, Harder JL, Nair V et al.. Precision nephrology identified tumor necrosis factor activation variability in minimal change disease and focal segmental glomerulosclerosis. Kidney international 2023. link 34 Sutkowska E, Fułek M, Fułek K, Fortuna P, Madziarska K. Nephrotic Syndrome - Different Risk of Venous Thromboembolism with Different Approaches to Justify Prophylactic Anticoagulation. Angiology 2023. link 35 Dadgar K, Xue Y, Chung J, Sangar S, Bhatt M, Chan AKC et al.. Childhood nephrotic syndrome and the clinical profile of thromboembolism: a systematic review and meta-analysis. Pediatric research 2023. link 36 Bharati J, Tiewsoh K, Dawman L, Singh T, Gorsi U, Rajarajen AP et al.. Long-term complications in patients with childhood-onset nephrotic syndrome. Pediatric nephrology (Berlin, Germany) 2023. link 37 Tijani A, Coons EM, Mizuki B, Dermady M, Stanilova K, Casey AL et al.. Direct Oral Anticoagulants Versus Warfarin for Venous Thromboembolism Prophylaxis in Patients With Nephrotic Syndrome: A Retrospective Cohort Study. The Annals of pharmacotherapy 2023. link 38 Mun-Wei L, Aiman-Mardhiyyah MY, Hayati AA, Ikram IM, Tai ELM, Shatriah I. Evaluation of Visual Acuity, Macular Thickness, and Level of Proteinuria in Children with Nephrotic Syndrome. Korean journal of ophthalmology : KJO 2023. link 39 Piccini CD, Morillos MB, Formoso CR, Rodrigues MADC, Londero RG. Increased cerebrospinal fluid pressure and nephrotic syndrome: A case report and literature review. Clinical neurology and neurosurgery 2023. link 40 Mithoowani S, Lim W. Adults with first-time nephrotic syndrome had increased risk for thromboembolic events, higher near time of diagnosis. Annals of internal medicine 2022. link 41 Banerjee S, Kamath N, Antwi S, Bonilla-Felix M. Paediatric nephrology in under-resourced areas. Pediatric nephrology (Berlin, Germany) 2022. link 42 Vestergaard SV, Birn H, Darvalics B, Nitsch D, Sørensen HT, Christiansen CF. Risk of Arterial Thromboembolism, Venous Thromboembolism, and Bleeding in Patients with Nephrotic Syndrome: A Population-Based Cohort Study. The American journal of medicine 2022. link 43 Meena J, Hari P, Sinha A, Bagga A. Efficacy and Safety of Combination Therapy with Tolvaptan and Furosemide in Children with Nephrotic Syndrome and Refractory Edema: A Prospective Interventional Study. Indian journal of pediatrics 2022. link 44 Veltkamp F, Rensma LR, Bouts AHM. Incidence and Relapse of Idiopathic Nephrotic Syndrome: Meta-analysis. Pediatrics 2021. link 45 Kuo MC, Liang PI, Chang JM. Podocentric view of glomerular proteinuria: Focused on cytoskeletal changes and toward promising targeted therapies and challenges. The Kaohsiung journal of medical sciences 2021. link 46 Sinha A, Bagga A, Banerjee S, Mishra K, Mehta A, Agarwal I et al.. Steroid Sensitive Nephrotic Syndrome: Revised Guidelines. Indian pediatrics 2021. link 47 Qiu Y, Coulson S, McIntyre CW, Wile B, Filler G. Adolescent and caregiver attitudes towards telemedicine use in pediatric nephrology. BMC health services research 2021. link 48 Sinha R, Agrawal N, Xue Y, Chanchlani R, Pradhan S, Raina R et al.. Use of rituximab in paediatric nephrology. Archives of disease in childhood 2021. link 49 Giliberti M, Mitrotti A, Gesualdo L. Podocytes: The Role of Lysosomes in the Development of Nephrotic Syndrome. The American journal of pathology 2020. link 50 Plotkin JB, Xu EJ, Fine DM, Knicely DH, Sperati CJ, Sozio SM. A Night Float System in Nephrology Fellowship: A Mixed Methods Evaluation. Kidney360 2020. link 51 George J, Alex S, Thomas ETA, Gracious N, Vineetha NS, Kumar S. Clinical Response and Pattern of B cell Suppression with Single Low Dose Rituximab in Nephrology. Kidney360 2020. link 52 Hamasaki Y, Hamada R, Muramatsu M, Matsumoto S, Aya K, Ishikura K et al.. A cross-sectional nationwide survey of congenital and infantile nephrotic syndrome in Japan. BMC nephrology 2020. link 53 Hari P, Khandelwal P, Smoyer WE. Dyslipidemia and cardiovascular health in childhood nephrotic syndrome. Pediatric nephrology (Berlin, Germany) 2020. link 54 Alves C, Pinho JF, Dos Santos LM, Magalhães G, da Silva JM, Fontes FL et al.. Augmentation index, a predictor of cardiovascular events, is increased in children and adolescents with primary nephrotic syndrome. Pediatric nephrology (Berlin, Germany) 2020. link 55 Niihata K, Nishiwaki H, Kurita N, Okada H, Maruyama S, Narita I et al.. Variations in actual practice patterns and their deviations from the clinical practice guidelines for nephrotic syndrome in Japan: certified nephrologists' questionnaire survey. Clinical and experimental nephrology 2019. link 56 Enya T, Miyazawa T, Miyazaki K, Oshima R, Morimoto Y, Okada M et al.. Pathologic tonsillar findings similar to IgA nephropathy and the role of tonsillectomy in a patient with nephrotic syndrome. BMC nephrology 2019. link 57 Kumar M, Ghunawat J, Saikia D, Manchanda V. Incidence and risk factors for major infections in hospitalized children with nephrotic syndrome. Jornal brasileiro de nefrologia 2019. link 58 Carpenter SL, Goldman J, Sherman AK, Selewski DT, Kallash M, Tran CL et al.. Association of infections and venous thromboembolism in hospitalized children with nephrotic syndrome. Pediatric nephrology (Berlin, Germany) 2019. link 59 Dumortier J, Sicard A, Guillaud O, Valette PJ, Scoazec JY, Boillot O. Portal Vein Thrombosis and Nephrotic Syndrome After Liver Transplant. Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation 2019. link 60 Sharp W, Olivero JJ. Venous Thrombosis in Nephrotic Syndrome. Methodist DeBakey cardiovascular journal 2018. link 61 Mahalingasivam V, Booth J, Sheaff M, Yaqoob M. Nephrotic syndrome in adults. Acute medicine 2018. link 62 Esezobor CI, Asinobi AO, Okafor HU, Akuse R, Gbadegesin R. National survey found that managing childhood nephrotic syndrome in Nigeria varied widely and did not comply with the best evidence. Acta paediatrica (Oslo, Norway : 1992) 2018. link 63 Gulati A, Somlo S. Whole exome sequencing: a state-of-the-art approach for defining (and exploring!) genetic landscapes in pediatric nephrology. Pediatric nephrology (Berlin, Germany) 2018. link 64 Gomes PPS, Lima FET, Araújo PR, Oliveira MR, Brito EGFM, Carneiro JL et al.. Water balance in pediatric nephrology: construction of a Standard Operating Procedure. Revista brasileira de enfermagem 2018. link 65 Lambe T, Frew E, Ives NJ, Woolley RL, Cummins C, Brettell EA et al.. Mapping the Paediatric Quality of Life Inventory (PedsQL™) Generic Core Scales onto the Child Health Utility Index-9 Dimension (CHU-9D) Score for Economic Evaluation in Children. PharmacoEconomics 2018. link 66 Zee J, Hodgin JB, Mariani LH, Gaut JP, Palmer MB, Bagnasco SM et al.. Reproducibility and Feasibility of Strategies for Morphologic Assessment of Renal Biopsies Using the Nephrotic Syndrome Study Network Digital Pathology Scoring System. Archives of pathology & laboratory medicine 2018. link 67 Tao SM, Kong X, Schoepf UJ, Wichmann JL, Shuler DC, Zhou CS et al.. Acute kidney injury in patients with nephrotic syndrome undergoing contrast-enhanced CT for suspected venous thromboembolism: a propensity score-matched retrospective cohort study. European radiology 2018. link 68 Akl K, Hazza I. Pediatric nephrology practice in Jordan. Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 2017. link 69 Dang YH. Using simplistic simulations to enhance learning in a nephrology pharmacotherapeutics module. Currents in pharmacy teaching & learning 2017. link 70 Karpman D, Höglund P. Orphan drug policies and use in pediatric nephrology. Pediatric nephrology (Berlin, Germany) 2017. link 71 Ruggeri P, Lo Bello F, Nucera F, Gaeta M, Monaco F, Caramori G et al.. Hereditary hyperhomocysteinemia associated with nephrotic syndrome complicated by artery thrombosis and chronic thromboembolic pulmonary hypertension: A case report. Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace 2017. link 72 Zhu JY, Fu Y, Richman A, Zhao Z, Ray PE, Han Z. A Personalized Model of . Journal of the American Society of Nephrology : JASN 2017. link 73 Iorember F, Aviles D. Anemia in nephrotic syndrome: approach to evaluation and treatment. Pediatric nephrology (Berlin, Germany) 2017. link 74 Trnka P, White MM, Renton WD, McTaggart SJ, Burke JR, Smith AC. A retrospective review of telehealth services for children referred to a paediatric nephrologist. BMC nephrology 2015. link 75 Lehmann R, Hanebeck B, Oberle S, Simon A, Choukair D, Tönshoff B et al.. Virtual patients in continuing medical education and residency training: a pilot project for acceptance analysis in the framework of a residency revision course in pediatrics. GMS Zeitschrift fur medizinische Ausbildung 2015. link 76 Palmer LG, Schnermann J. Integrated control of Na transport along the nephron. Clinical journal of the American Society of Nephrology : CJASN 2015. link 77 Fukui S, Mitsuno M, Yamamura M, Tanaka H, Ryomoto M, Uenaka H et al.. Right ventricular thrombus in a patient with nephrotic syndrome. General thoracic and cardiovascular surgery 2015. link 78 Tavil B, Kara F, Topaloglu R, Aytac S, Unal S, Kuskonmaz B et al.. Case series of thromboembolic complications in childhood nephrotic syndrome: Hacettepe experience. Clinical and experimental nephrology 2015. link 79 Rybi-Szumińska A, Wasilewska A, Michaluk-Skutnik J, Osipiuk-Remża B, Fiłonowicz R, Zając M. Are oxidized low-density lipoprotein and C-reactive protein markers of atherosclerosis in nephrotic children?. Irish journal of medical science 2015. link 80 Mammen C, Matsell DG, Lemley KV. The importance of clinical pathways and protocols in pediatric nephrology. Pediatric nephrology (Berlin, Germany) 2014. link 81 Samuel S, Bitzan M, Zappitelli M, Dart A, Mammen C, Pinsk M et al.. Canadian Society of Nephrology Commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis: management of nephrotic syndrome in children. American journal of kidney diseases : the official journal of the National Kidney Foundation 2014. link 82 Wightman AG, Oron AP, Symons JM, Flynn JT. Pediatric nephrologists' beliefs regarding randomized controlled trials. Journal of investigative medicine : the official publication of the American Federation for Clinical Research 2014. link 83 Kerlin BA, Haworth K, Smoyer WE. Venous thromboembolism in pediatric nephrotic syndrome. Pediatric nephrology (Berlin, Germany) 2014. link 84 Medjeral-Thomas N, Ziaj S, Condon M, Galliford J, Levy J, Cairns T et al.. Retrospective analysis of a novel regimen for the prevention of venous thromboembolism in nephrotic syndrome. Clinical journal of the American Society of Nephrology : CJASN 2014. link 85 Suri D, Ahluwalia J, Saxena AK, Sodhi KS, Singh P, Mittal BR et al.. Thromboembolic complications in childhood nephrotic syndrome: a clinical profile. Clinical and experimental nephrology 2014. link 86 Tojo A. The role of the kidney in protein metabolism: the capacity of tubular lysosomal proteolysis in nephrotic syndrome. Kidney international 2013. link 87 Lombel RM, Hodson EM, Gipson DS. Treatment of steroid-resistant nephrotic syndrome in children: new guidelines from KDIGO. Pediatric nephrology (Berlin, Germany) 2013. link 88 Lombel RM, Gipson DS, Hodson EM. Treatment of steroid-sensitive nephrotic syndrome: new guidelines from KDIGO. 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High frequency of aspirin resistance in patients with nephrotic syndrome. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2012. link 95 Kaneko K, Kimata T, Tsuji S, Shimo T, Takahashi M, Tanaka S. Serum albumin level accurately reflects antioxidant potentials in idiopathic nephrotic syndrome. Clinical and experimental nephrology 2012. link 96 Greff B, Faivre J, Carli PA, Niaudet P, Orliaguet GA. Intra- and postoperative adverse events in children with nephrotic syndrome requiring surgery under general anesthesia. Paediatric anaesthesia 2012. link 97 Li HQ, Wu J, Niu DM, Shi YH, Zhang CN, Wang JJ. The level of native and oxidized lipoprotein(a) in children with nephrotic syndrome. Clinical biochemistry 2012. link 98 Erdur FM, Soyoral YU, Emre H, Begenik H, Canbaz ET, Erkoc R. Fenofibrate-induced rhabdomyolysis in a patient with chronic renal failure due to nephrotic syndrome: a rare case report. Clinical biochemistry 2012. link 99 Zhang LJ, Wang ZJ, Zhou CS, Lu L, Luo S, Lu GM. Evaluation of pulmonary embolism in pediatric patients with nephrotic syndrome with dual energy CT pulmonary angiography. Academic radiology 2012. link 100 Sparks MA, O'Seaghdha CM, Sethi SK, Jhaveri KD. Embracing the Internet as a means of enhancing medical education in nephrology. American journal of kidney diseases : the official journal of the National Kidney Foundation 2011. link

    Original source

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