Epidemiology
- Prevalence: 21% of cases have a pleural effusion
Etiology
Physiology
- Decreased plasma oncotic pressure with transudation of fluid
Diagnosis
Clinical
Renal Manifestations
Systemic Manifestations
Hematologic Manifestations
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
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
References