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Nephrotic syndrome with concurrent effusion from a different cause: A case series
Adarsh Kumar1, Sanjiv Mahajan1, Rajesh Kumar1
1Department of Nephrology, VMMC and Safdarjung Hospital, New Delhi, India.
Journal of Family Medicine and Primary Care
|June 23, 2025
Summary
Nephrotic syndrome patients can have persistent fluid buildup despite treatment. This study explores uncommon causes like infections and structural defects, highlighting the need for early diagnosis.
Area of Science:
- Nephrology
- Internal Medicine
- Pathophysiology
Background:
- Nephrotic syndrome commonly causes generalized edema (anasarca) responsive to diuretics or remission.
- Persistent third space fluid collections (peritoneal, pleural, pericardial) can occur despite treatment.
- Identifying non-responsive fluid accumulation requires investigating coexisting etiologies.
Observation:
- This case series details five nephrotic syndrome patients with persistent effusions.
- Etiologies included two infectious (tuberculosis) and three non-infectious (diaphragmatic defect, cirrhosis, chylous ascites) causes.
- Patients achieved disease remission or adequate diuresis, yet effusions persisted.
Findings:
- Persistent effusions in nephrotic syndrome can stem from diverse, often non-renal, causes.
- Diagnostic challenges arise in differentiating primary nephrotic syndrome complications from secondary fluid collections.
- Early identification of underlying causes is crucial for effective management.
Implications:
- Highlights the importance of a broad differential diagnosis for refractory effusions in nephrotic syndrome.
- Underscores the need for timely investigation beyond standard nephrotic syndrome management.
- Suggests that prompt intervention based on identifying secondary causes can improve patient outcomes.
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