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Updated: Jun 17, 2025

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Nephrotic Syndrome Without Nephrotic Range Proteinuria.

Jibran A Sheikh¹, Usheem Syed¹, Sayed M Osama²

¹Internal Medicine, Central Michigan University College of Medicine, Saginaw, USA.

|August 12, 2024

Summary

This summary is machine-generated.

Nephrotic syndrome can occur even without the standard 3.5g/24h proteinuria threshold. This case highlights systemic amyloid light chain (AL) amyloidosis causing nephrotic syndrome with lower proteinuria levels due to liver disease.

Keywords:

albumin clearance hepatic amyloidosis nephrotic syndrome nephrotic-range proteinuria systemic amyloidosis

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5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat

Published on: July 3, 2013

Area of Science:

Nephrology
Internal Medicine
Hematology

Background:

Nephrotic syndrome is typically defined by proteinuria ≥3.5g/24h, low serum albumin, edema, and hyperlipidemia.
This definition's arbitrary threshold may not capture all cases with glomerular permeability defects.

Observation:

A 57-year-old male presented with severe edema, fatigue, and reduced urine output.
Laboratory results showed low serum albumin (1.3 g/dL), moderate proteinuria (2.3g/24h), and hypercholesterolemia.
Renal biopsy revealed amyloid light chain (AL) amyloidosis, confirmed by bone marrow biopsy.

Findings:

A diagnosis of nephrotic syndrome secondary to systemic AL amyloidosis was established, despite proteinuria below the 3.5g/24h threshold.
Concurrent hepatic amyloidosis was identified through various imaging and laboratory tests.
Reduced albumin synthesis due to liver disease can lead to nephrotic syndrome at lower proteinuria levels.

Implications:

This case challenges the rigid diagnostic criteria for nephrotic syndrome.
It underscores the importance of considering systemic diseases like AL amyloidosis in atypical presentations.
Accurate diagnosis is crucial for timely and appropriate management of nephrotic syndrome and its underlying causes.