Name of the Condition

• Nephrotic Syndrome with Unspecified Morphologic Changes
• ICD-10 Code N04.9

Summary

Nephrotic syndrome with unspecified morphologic changes is a kidney disorder characterized by a set of symptoms that include high levels of protein in the urine, low blood protein levels, high cholesterol levels, and swelling, particularly in the ankles and feet. The "unspecified morphologic changes" suggests that the precise underlying kidney changes are not identified.

Causes

• Primary kidney diseases (e.g., minimal change disease, focal segmental glomerulosclerosis)
• Secondary causes such as diabetes, infections, medications, and systemic diseases
• Sometimes, no specific cause is identified.

Risk Factors

• Genetic predisposition
• Certain medical conditions (e.g., diabetes, lupus)
• Infections (e.g., hepatitis B and C, HIV)
• Use of specific drugs (e.g., NSAIDs)

Symptoms

• Severe swelling (edema), especially around the eyes, feet, and ankles
• Foamy urine due to excess protein
• Weight gain from fluid retention
• Fatigue and loss of appetite

Diagnosis

• Urine tests to check for proteinuria
• Blood tests to measure kidney function and blood protein levels
• Kidney biopsy may be performed to identify underlying kidney changes

Treatment Options

• Corticosteroids or other immunosuppressants to reduce inflammation
• Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to manage blood pressure and reduce protein loss
• Diuretics to reduce fluid retention
• Dietary modifications, including reducing sodium and, in some cases, protein intake

Prognosis and Follow-Up

• Prognosis varies depending on underlying causes and response to treatment
• Regular monitoring of kidney function, blood pressure, and protein levels in urine is essential
• Some patients may achieve remission, while others might require long-term management

Complications

• Increased risk of infections due to loss of immunoglobulins
• Blood clots due to changes in blood clotting factors
• Acute kidney injury or chronic kidney disease if untreated
• Malnutrition due to protein loss

Lifestyle & Prevention

• Maintaining a balanced, low-sodium diet
• Regular exercise and healthy weight maintenance
• Avoiding medications that may damage the kidneys
• Monitoring and controlling blood pressure and blood sugar

When to Seek Professional Help

• Sudden increase in swelling
• Decreased urine output or changes in urine appearance
• Sudden weight gain indicating fluid retention
• Signs of infection, such as fever

Additional Resources

• National Kidney Foundation (https://www.kidney.org)
• American Society of Nephrology (https://www.asn-online.org)
• NephCure Kidney International (https://nephcure.org)

Tips for Medical Coders

• Ensure accurate documentation and identification of the underlying disease or secondary cause if available
• Avoid assuming specific morphologic changes not supported by medical records
• Familiarize with related codes for more specific conditions if biopsy results are available