Epidemiology

• Prevalence: 21% of cases have a pleural effusion

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Etiology

• xxxx

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Physiology

• Decreased plasma oncotic pressure with transudation of fluid

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Diagnosis

• xxx

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Clinical

Renal Manifestations

• Proteinuria (see Proteinuria, [[Proteinuria]])

Systemic Manifestations

• Edema

Hematologic Manifestations

• Hypercoagulable State (see Hypercoagulable States, [[Hypercoagulable States]]): predisposed acute PE, etc.

Pulmonary Manifestations

• Pleural Effusion (see Pleural Effusion-Transudate, [[Pleural Effusion-Transudate]])
  • 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

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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

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References

• xxx