Nephrotic Syndrome Clinical Presentation

Updated: Nov 23, 2021
  • Author: Ramapriya Sinnakirouchenan, MD, MBBS; Chief Editor: Vecihi Batuman, MD, FASN  more...
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The first sign of nephrotic syndrome in children is usually swelling of the face; this is followed by swelling of the entire body. Adults can present with dependent edema. Foamy urine may be a presenting feature. Fatigue and loss of appetite are common symptoms. A thrombotic complication, such as deep venous thrombosis of the calf veins or even a pulmonary embolus, may be the first clue to nephrotic syndrome.

Additional historical features can be related to the cause of nephrotic syndrome. Thus, the recent start of a nonsteroidal anti-inflammatory drug (NSAID) suggests such drugs as the cause and a more than 10-year history of diabetes with symptomatic neuropathy indicates diabetic nephropathy.


Physical Examination

Edema is the salient feature of nephrotic syndrome and initially develops around the eyes and legs. With time, the edema becomes generalized and may be associated with an increase in weight, the development of ascites, or pleural effusions.

Hematuria and hypertension manifest in a minority of patients.

Additional features on exam will vary according to cause and as a result of whether or not renal function impairment exists. Thus, in the case of longstanding diabetes, the patient may have diabetic retinopathy, which correlates closely with diabetic nephropathy. If the kidney function is reduced, the patient may have hypertension, anemia, or both.