Nephrotic syndrome is the end result of a number of diseases that damage the glomerular capillaries in the kidney. The glomerulus is the site of blood filtration and the onset of urine formation. Normally, the capillary pores are too small to allow large blood components to pass through. However, many diseases increase capillary permeability (ability of substances to pass through capillary walls into tissue spaces), and this allows large amounts of protein to pass into the urine.

Any of the following disorders that affect the glomerulus may cause nephrotic syndrome: multisystem diseases [diabetes mellitus, systemic lupus erythematosus (SLE)]); vascular system diseases (vasculitis, sickle cell anemia); infections; metabolic abnormalities; and neoplasms.

A large amount of protein is lost in the urine with resulting hypoalbuminemia (decreased albumin in the blood), and edema (swelling) of the eyelids, abdomen and feet. Chronic formation of thrombi in the renal vein and pulmonary emboli result from hypercoagulability (increased ability of the blood to solidify). Hyperlipidemia (increased fat in the blood) occurs due to decreased serum proteins. Fatty casts appear in the urine, and the blood and triglyceride level is increased.

Urine studies will show large amounts of protein in the urine. A renal biopsy maybe performed for a precise diagnosis.

Treatment is aimed at the presenting symptoms. Management is focused on the underlying disease and reduction in the loss of protein by low-sodium, high-protein diets and use of loop diuretics. Complications of blocked vessels by clots (thromboembolism) require anticoagulants and lipid-lowering drugs. Some forms of nephrotic syndrome (NS) show a dramatic response to corticosteroids. Diabetic nephrosis is managed by using measures to control the diabetes and to treat the edema.

End-stage renal disease due to diabetes mellitus leads to transplant or dialysis. Patients with renal transplants are noted to have a longer survival rate at 5 years than those who had dialysis, only. Remissions are possible in lupus glomerulonephritis.

• This disease, (condition), only in its active form , has a 3 year presumptive period and shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied. [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309(a). [chronic disease].

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• The new criteria for the Genitourinary Disease and Conditions body system became effective November 14, 2021.  Review both current and historic criteria prior to any reduction for disabilities established before that date.  38 CFR 3.951(a)

• When evaluating any claim involving loss or loss of use of one or more creative organs, refer to 38 CFR 3.350 of this chapter to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.

• GFR, estimated GFR (eGFR), and creatinine-based approximations of GFR will be accepted for evaluation purposes when determined to be appropriate and calculated by a medical professional.