nephrotic

Nephrotic is an adjective used in medicine to describe the features of nephrotic syndrome, a clinical state arising from glomerular disease characterized by heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Proteinuria is typically defined as excretion of more than 3.5 grams of protein per day in urine, or an elevated urine protein-to-creatinine ratio. Hypoalbuminemia reduces plasma oncotic pressure, leading to edema, while the liver increases lipoprotein synthesis, causing hyperlipidemia.

Causes include primary glomerular diseases such as minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy; and systemic diseases such as diabetic nephropathy, lupus nephritis, amyloidosis, as well as infectious or drug-related etiologies.

Diagnosis relies on urinalysis and quantitative protein loss, serum albumin, lipid panel, and assessment of kidney function. If the cause is unclear, kidney biopsy may be required to classify the underlying pathology and guide treatment.

Management focuses on treating the underlying cause and reducing proteinuria and edema. General measures include salt restriction and diuretics; renin–angiotensin system blockade with ACE inhibitors or ARBs to reduce proteinuria and protect renal function; lipid-lowering therapy as needed. Immunosuppressive therapy is used for selected diseases (for example corticosteroids in minimal change disease, or other agents for FSGS or membranous nephropathy).

Prognosis varies by underlying disease and patient age; children with minimal change disease typically respond well to steroids, while adults have a wider range of outcomes. Complications include increased infection risk, thromboembolism, and in some cases progression to chronic kidney disease.

Nephrotic is distinct from nephritic syndrome, which features hematuria, hypertension, and azotemia with less severe proteinuria.