Epidemiology: present in 21% of nephrotic syndrome cases
Diagnosis
CXR/Chest CT
Usually bilateral
Frequently subpulmonic
Presence of unilateral or asymmetric effusion should raise suspicion for acute PE or infection (in one series of cases with nephrotic syndrome and effusion, 22% of patients had acute PE)
V/Q Scan: may be necessary to rule out acute PE (since effusion can be transudative or less commonly, exudative in acute PE)
Thoracentesis: usually required to rule out acute PE, etc
Treatment
Treatment to increase plasma oncotic pressure and decrease proteinuria:
Therapeutic thoracenteses: not indicated (since protein depletion may occur)
Pleurodesis: may be required in some cases with persistent symptomatic effusion despite aggressive therapy of nephrotic syndrome