Differential Diagnosis for Nephrotic Syndrome with Cardiac Dysfunction

Single Most Likely Diagnosis

• Focal Segmental Glomerulosclerosis (FSGS): This is a common cause of nephrotic syndrome in adults and can lead to cardiac dysfunction due to the loss of large amounts of protein in the urine, resulting in hypoalbuminemia, which can cause decreased oncotic pressure and subsequent edema. The strain on the heart from fluid overload can lead to cardiac dysfunction.

Other Likely Diagnoses

• Membranous Nephropathy: Another common cause of nephrotic syndrome, which can also lead to cardiac dysfunction through similar mechanisms as FSGS, including fluid overload and potential for thromboembolic events due to the hypercoagulable state associated with nephrotic syndrome.
• Diabetic Nephropathy: A leading cause of nephrotic syndrome, especially in patients with long-standing diabetes. Cardiac dysfunction can occur due to diabetic cardiomyopathy, fluid overload, or other cardiovascular complications associated with diabetes.
• Amyloidosis: Can cause both nephrotic syndrome and cardiac dysfunction. The deposition of amyloid fibrils in the kidneys leads to proteinuria, while deposition in the heart can cause restrictive cardiomyopathy.

Do Not Miss Diagnoses

• Minimal Change Disease with Secondary Cardiac Involvement: Although less common in adults, minimal change disease can cause nephrotic syndrome. The cardiac dysfunction might not be directly related to the renal disease but could be due to other factors like hypertension or fluid overload.
• Lupus Nephritis: Systemic lupus erythematosus (SLE) can cause both nephrotic syndrome and cardiac dysfunction. The cardiac involvement could be due to lupus cardiitis, pericarditis, or other mechanisms.
• HIV-associated Nephropathy (HIVAN): Can cause nephrotic syndrome, and HIV infection is also associated with various forms of cardiac dysfunction, including cardiomyopathy and pulmonary hypertension.

Rare Diagnoses

• Light Chain Deposition Disease: A rare condition characterized by the deposition of light chain immunoglobulins in various tissues, including the kidneys and heart, leading to nephrotic syndrome and cardiac dysfunction.
• Fabry Disease: A genetic disorder that can cause nephrotic syndrome due to the accumulation of globotriaosylceramide in the kidneys and cardiac dysfunction due to its accumulation in the heart, leading to hypertrophic cardiomyopathy.
• Alport Syndrome: A genetic disorder affecting the type IV collagen in the kidneys, ears, and eyes. It can lead to nephrotic syndrome and, in some cases, cardiac abnormalities, although these are less common.