What are the signs and symptoms of nephrotic syndrome in children?

Updated: Mar 04, 2020
  • Author: Jerome C Lane, MD; Chief Editor: Craig B Langman, MD  more...
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Pitting edema is the presenting symptom in about 95% of children with nephrotic syndrome. Edema is typically found in the lower extremities, face and periorbital regions, scrotum or labia, and abdomen (ascites). It is not uncommon for periorbital swelling to be mistaken for an allergic reaction by caretakers and primary care providers, until the progression of the edema or urine testing indicates a different origin.

Other signs and symptoms of nephrotic syndrome may include the following:

  • Viral respiratory tract infection: A history of a respiratory tract infection immediately preceding the onset of nephrotic syndrome is frequent on initial presentation and on subsequent relapses.

  • Allergy: Approximately 30% of children with nephrotic syndrome have a history of allergy. [1]

  • Microhematuria: Gross or macroscopic hematuria is rare and may indicate a complication such as infection or renal vein thrombosis.

  • Symptoms of infection: May include fever, lethargy, irritability, or abdominal pain due to sepsis or peritonitis.

  • Hypotension and signs of shock: Can be present in children presenting with sepsis.

  • Respiratory distress: Due to either massive ascites and thoracic compression or frank pulmonary edema and effusions, or both.

  • Seizure: Caused by cerebral thrombosis.

  • Anorexia

  • Abdominal discomfort, pain, and peritoneal signs: Resulting from spontaneous bacterial peritonitis, ascites, or bowel wall edema.

  • Diarrhea: Due to bowel wall edema or malabsorption.

  • Hypertension: Resulting from fluid overload or primary kidney disease (unusual in minimal change disease).

See Presentation for more detail.

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