History

Facial edema is noted first. Edema may be preceded by an upper respiratory tract infection, an allergic reaction to a bee sting, the use of certain drugs, or malignancies.

Malaise and easy fatigability can occur. Weight gain often is an additional feature.

The patient also may present with one or more of the following:

Hypovolemia
Hypertension
Thromboembolism
Infection

Physical Examination

The blood pressure usually is normal in children^[24]but may be elevated in adults. (In addition, the plasma creatinine in adults is often slightly elevated at presentation.)

Dependent edema is the most prominent sign. The retina has a wet appearance. Subungual edema with horizontal lines (called Muehrcke lines) also may occur.

Hernias may be found, and the elasticity of the ears may be decreased.

Heavy proteinuria over an extended period of time leads to a state of protein depletion with muscle wasting, thinning of the skin, and growth failure.

Pleural and ascitic fluid can accumulate. Rarely, cellulitis, peritonitis, or pneumonia may be the first indication of an underlying nephrotic syndrome.

Children may have growth failure.

Differential Diagnoses

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Author

Abeera Mansur, MD Consultant Nephrologist, Doctors Hospital and Medical Center, Pakistan; Nephrologist, CHI Health Good Samaritan of Kearney, Nebraska

Abeera Mansur, MD is a member of the following medical societies: American College of Physicians, American Society of Nephrology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eleanor Lederer, MD, FASN Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD, FASN is a member of the following medical societies: American Association for the Advancement of Science, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Society of Nephrology<br/>Received income in an amount equal to or greater than $250 from: Healthcare Quality Strategies, Inc.

Chief Editor

Vecihi Batuman, MD, FASN Professor of Medicine, Section of Nephrology-Hypertension, Deming Department of Medicine, Tulane University School of Medicine

Vecihi Batuman, MD, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Anil Kumar Mandal, MD Clinical Professor, Department of Internal Medicine, Division of Nephrology, University of Florida College of Medicine

Anil Kumar Mandal, MD is a member of the following medical societies: American College of Clinical Pharmacology, American College of Physicians, American Society of Nephrology, Central Society for Clinical and Translational Research

Disclosure: Nothing to disclose.

Susie Lew, MD Professor of Medicine, Department of Medicine, Division of Renal Diseases and Hypertension, George Washington Unversity School of Medicine and Health Sciences; Medical Director, Peritoneal Dialysis Unit, George Washington University Medical Center, Gambro Healthcare/DaVita

Susie Lew, MD is a member of the following medical societies: American College of Physicians, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation

Disclosure: Received grant/research funds from Amgen for investigator; Received consulting fee from Gambro for consulting; Received grant/research funds from Questcor for investigator; Received grant/research funds from Bristol Meyers Squibb for investigator; Received grant/research funds from CMS for investigator.

Florin Georgescu, MD Consulting Staff, Kidney Specialists of Savannah

Florin Georgescu, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Nephrology

Disclosure: Nothing to disclose.

Minimal-Change Disease Clinical Presentation

History

Physical Examination

References

Tables

Contributor Information and Disclosures

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