Nephrotic syndrome is characterized by proteinuria and edema due to some form of glomerulonephritis. The resulting fall in plasma protein concentration decreases vascular volume, which leads to diminished renal blood flow. This in turn causes secondary aldosteronism characterized by Na+ and water retention and K+ depletion. Rigid control of dietary Na+ is essential. Therapy of the nephrotic syndrome using a thiazide (possibly with a K+-sparing diuretic) to control the secondary aldosteronism, is a useful initial approach to treatment. Since nephrotic edema is frequently more difficult to control than cardiac edema, it may be necessary to switch to a loop diuretic (and spironolactone) to obtain adequate diuresis.
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