What are the key clinical features to consider when diagnosing nephrotic syndrome in adults?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Key clinical features to consider when diagnosing nephrotic syndrome in adults include:

  • Peripheral oedema: Typically presents as swelling in the lower limbs and periorbital areas due to hypoalbuminaemia and fluid retention .
  • Proteinuria: Heavy proteinuria exceeding 3.5 g/day is a hallmark, often detected by urine dipstick or 24-hour urine collection .
  • Hypoalbuminaemia: Serum albumin levels are reduced, usually below 25-30 g/L, reflecting urinary protein loss .
  • Hyperlipidaemia: Elevated serum cholesterol and triglycerides are common secondary features due to altered lipid metabolism .
  • Foamy urine: Due to proteinuria, patients may report foamy or frothy urine .
  • Possible hypertension: Although not universal, some patients may present with elevated blood pressure, which requires assessment .
  • Signs of underlying cause or complications: Such as systemic symptoms (e.g., rash, arthralgia) suggesting secondary nephrotic syndrome, or thromboembolic events due to hypercoagulability .

Diagnosis is supported by laboratory findings including urinalysis confirming heavy proteinuria, serum biochemistry showing hypoalbuminaemia and hyperlipidaemia, and clinical examination revealing oedema. The integration of these features is essential for accurate diagnosis and to guide further investigation and management .

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