Understanding Nephrotic Syndrome diagnosis, treatment, and management. Find information on clinical documentation, medical coding (ICD-10 codes N04), proteinuria, edema, hypoalbuminemia, hyperlipidemia, and renal biopsy. Learn about the pathophysiology, symptoms, and complications of Nephrotic Syndrome for healthcare professionals, including physicians, nurses, and medical coders. Explore resources for accurate diagnosis coding and effective patient care related to Nephrotic Syndrome.
Also known as
Nephrotic syndrome
Kidney disorder with proteinuria, edema, and hypoalbuminemia.
Nephritic syndrome
Kidney inflammation with hematuria, proteinuria, and hypertension.
Abnormal findings in urine
Includes proteinuria and other urinary abnormalities related to kidney disease.
Malnutrition
Can be a complication of nephrotic syndrome due to protein loss.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the nephrotic syndrome congenital?
Yes
Is it Finnish type?
No
Is it due to a systemic disease?
When to use each related code
| Description |
|---|
| Nephrotic syndrome |
| Focal segmental glomerulosclerosis |
| Minimal change disease |
Coding nephrotic syndrome without specifying the type of proteinuria (e.g., selective, non-selective) can lead to inaccurate severity and DRG assignment.
Failing to code the underlying etiology of nephrotic syndrome (e.g., diabetes, lupus) impacts data integrity for quality reporting and research.
Discrepancies between clinical documentation and coded diagnoses (e.g., nephritis vs. nephrosis) create compliance risks and potential denials.
Q: What are the most effective diagnostic strategies for differentiating between minimal change disease and focal segmental glomerulosclerosis (FSGS) in adults presenting with nephrotic syndrome?
A: Differentiating minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) in adults with nephrotic syndrome can be challenging due to overlapping clinical presentations. While both conditions manifest with proteinuria, hypoalbuminemia, and edema, distinguishing them requires a combination of clinical and histopathological assessment. Consider the following: age (MCD is more common in children, while FSGS is more prevalent in adults), response to corticosteroids (MCD typically shows a good response, whereas FSGS is often steroid-resistant), and renal biopsy findings. A renal biopsy is often necessary for definitive diagnosis. Histologically, MCD shows normal glomeruli on light microscopy and effacement of podocyte foot processes on electron microscopy. FSGS, on the other hand, demonstrates segmental scarring of glomeruli. Explore how specific staining patterns on immunofluorescence can further aid in distinguishing subtypes of FSGS and guide treatment decisions. Learn more about the utility of genetic testing in cases of suspected hereditary FSGS.
Q: How should I manage a patient with nephrotic syndrome who presents with refractory edema despite aggressive diuretic therapy?
A: Refractory edema in nephrotic syndrome, despite aggressive diuretic use, is a common clinical challenge and can significantly impact patient comfort and outcomes. In such cases, consider implementing a combination of strategies. First, optimize diuretic therapy by exploring the use of loop diuretics in conjunction with thiazide diuretics or metolazone to achieve synergistic effects. Closely monitor electrolyte levels and kidney function, as these patients are at risk for electrolyte imbalances and acute kidney injury. If diuretic resistance persists, consider adding albumin infusions, which can transiently increase serum albumin levels and improve diuresis. However, the benefit of albumin infusions is often short-lived. Strict fluid and sodium restriction is essential. Explore how ultrafiltration can be a useful option for fluid removal in patients with severe edema refractory to medical therapy. Learn more about the role of newer therapies, such as vasopressin receptor antagonists, in managing resistant edema.
Patient presents with classic signs and symptoms suggestive of nephrotic syndrome. Presenting complaints include edema, specifically periorbital edema and lower extremity swelling, along with foamy urine. The patient reports decreased urine output and recent weight gain. Review of systems reveals fatigue and loss of appetite. Physical examination confirms the presence of pitting edema in the lower extremities. Laboratory findings demonstrate significant proteinuria exceeding 3.5 grams per 24 hours, hypoalbuminemia with serum albumin less than 3.0 gdL, hyperlipidemia evident by elevated cholesterol and triglyceride levels, and microscopic hematuria. Differential diagnosis includes minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and diabetic nephropathy. Based on the clinical presentation, laboratory results, and absence of other identifiable causes, a diagnosis of nephrotic syndrome is established. Treatment plan includes initiation of corticosteroids, specifically prednisone, to reduce proteinuria and control edema. Patient education provided on medication management, dietary modifications including sodium restriction, and monitoring for signs of infection. Referral to nephrology for further evaluation and management, including renal biopsy to determine the underlying cause of nephrotic syndrome, is scheduled. Follow-up appointment scheduled in two weeks to assess response to therapy and adjust treatment as needed. ICD-10 code N04 is applied. CPT codes for evaluation and management services, laboratory tests, and potential renal biopsy are documented for billing purposes.