Adult-Onset Nephrotic Syndrome in a Young Male: A Case Report with Clinical and Pharmacological Management

Abstract

Background: Nephrotic syndrome is a glomerular disorder characterised by heavy proteinuria, hypoalbuminaemia, oedema, and hyperlipidaemia, resulting from podocyte and filtration barrier injury and seen in diverse primary and secondary renal diseases. Aims: To present and discuss a case of adult-onset nephrotic syndrome in a young male, describing its clinical features, laboratory profile, diagnostic approach, and pharmacological management in the light of current evidence. Presentation of Case: A 30-year-old male with no prior comorbidities presented with bilateral pitting pedal oedema of three days' duration. Laboratory investigations confirmed significant proteinuria (+++), markedly reduced serum albumin (2.3 g/dL), reduced total serum protein (5.7 g/dL), and mild lymphopenia. Elevated alkaline phosphatase (142 U/L) was also noted. Nephrotic-range proteinuria was strongly suspected clinically, although quantitative 24-hour urinary protein estimation was unavailable. Ultrasonography identified an incidental gallbladder polyp and non-obstructive left renal calculus. A clinical diagnosis of adult-onset nephrotic syndrome was established on the basis of the cardinal biochemical and clinical features. Discussion and Conclusion: The clinical, biochemical, and urinalysis findings were consistent with the diagnostic criteria for nephrotic syndrome. Management comprised a sequential diuretic regimen (furosemide IV, furosemide–spironolactone oral, metolazone), empirical antimicrobial therapy (ceftriaxone, cefpodoxime proxetil), supportive haemostatic therapy (phytomenadione, tranexamic acid), and antiemetic cover (ondansetron). Clinical improvement was achieved. The case underscores the importance of early recognition, systematic investigation, and evidence-based pharmacological intervention in adult-onset nephrotic syndrome, with renal biopsy recommended for definitive histological diagnosis and targeted therapy.