Differential Diagnosis for Nephrotic Syndrome with Abdominal Pain

Given a known case of nephrotic syndrome with a long history presenting with generalized abdominal pain and tenderness, the possible complications can be categorized as follows:

• Single Most Likely Diagnosis

  • Peritonitis: This is a likely complication due to the increased risk of infections in patients with nephrotic syndrome, especially spontaneous bacterial peritonitis, which can occur without any obvious source of infection.

• Other Likely Diagnoses

  • Gastritis: Patients with nephrotic syndrome may have an increased risk of gastritis due to the use of non-steroidal anti-inflammatory drugs (NSAIDs) or steroids as part of their treatment regimen.
  • Pancreatitis: Although less common, pancreatitis can occur in patients with nephrotic syndrome, possibly related to hypertriglyceridemia, which is a known complication of nephrotic syndrome.

• Do Not Miss Diagnoses

  • Thrombosis: Although not directly related to abdominal pain, thrombosis (including renal vein thrombosis) is a critical complication in nephrotic syndrome that can present with abdominal pain and must not be missed due to its high morbidity and mortality.
  • Sepsis: Sepsis can present with non-specific symptoms including abdominal pain and is a life-threatening condition that requires immediate attention.

• Rare Diagnoses

  • Amyloidosis: A rare complication of long-standing nephrotic syndrome, which can involve the gastrointestinal tract and present with abdominal pain.
  • Hepatic Vein Thrombosis (Budd-Chiari Syndrome): Although rare, this condition can occur in patients with nephrotic syndrome due to hypercoagulability and present with abdominal pain.