Nephrotic syndrome with concurrent effusion from a different cause: A case series

The nephrotic syndrome presents clinically with anasarca characterized by peripheral edema, ascites, pleural effusion, or rarely pericardial effusions. The anasarca disappears with adequate diuretic therapy if there is no diuretic resistance or with disease remission. However, these patients may sometimes experience persistent unusual fluid collection in the third space, viz. peritoneal cavity, pleural cavity, and pericardial cavity, despite adequate diuretic response or disease remission, which may be because of coexisting different etiology that is leading to unusual fluid collection. This case series aims to describe two infective (tubercular) and three non-infective (structural diaphragmatic defect, liver cirrhosis, and chylous ascites) etiologies of persistent effusion in five patients of nephrotic syndrome despite achieving disease remission or adequate diuresis, the diagnostic challenges faced, and the importance of early detection for timely intervention.