Differential Diagnosis for Fever in Nephrotic Syndrome
Single Most Likely Diagnosis
- Pneumonia: Patients with nephrotic syndrome are at increased risk of infections due to immunoglobulin loss in the urine and edema, which can predispose to aspiration. Pneumonia is a common and serious infection in these patients.
Other Likely Diagnoses
- Urinary Tract Infections (UTIs): The loss of immunoglobulins and the presence of edema can increase the risk of UTIs in patients with nephrotic syndrome.
- Cellulitis: Edema associated with nephrotic syndrome can increase the risk of skin infections like cellulitis.
- Peritonitis: Spontaneous bacterial peritonitis can occur, especially if there is significant ascites, although this is more commonly associated with cirrhosis.
Do Not Miss Diagnoses
- Sepsis: Although not unique to nephrotic syndrome, sepsis is a life-threatening condition that can arise from any infection and must be promptly recognized and treated.
- Endocarditis: Patients with nephrotic syndrome may have an increased risk of infections, including endocarditis, especially if they have underlying heart disease.
- Pneumocystis jirovecii Pneumonia (PCP): Particularly in patients on immunosuppressive therapy for their nephrotic syndrome, PCP is a critical diagnosis to consider due to its high mortality if untreated.
Rare Diagnoses
- Tuberculosis (TB): While not as common, TB can be a cause of fever in patients with nephrotic syndrome, especially in endemic areas or in those with significant immunosuppression.
- Fungal Infections: In patients with nephrotic syndrome who are on immunosuppressive therapy, fungal infections can be a rare but serious cause of fever.
- Vasculitis: Certain types of vasculitis, such as ANCA-associated vasculitis, can present with fever and renal involvement, although they are less common causes of fever in the context of nephrotic syndrome.