Edema is a common complication of numerous renal disease. In the recent past several aspects of the pathophysiology of this condition have been elucidated. We herein present a case of nephrotic syndrome in a 30 year-old men. The discussion revolves around the following key questions on fluid accumulation in renal disease: 1.

What is edema? What diseases can cause edema?

2.

What are the mechanisms of edema in nephrotic syndrome? 2a.

The “underfill” theory

2b.

The “overfill” theory

2c.

Tubulointerstitial inflammation

2d.

Vascular permeability

3.

What are the mechanisms of edema in nephritic syndrome?

4.

How can the volume status be assessed in patients with nephrotic syndrome?

5.

What are therapeutic strategies for edema management?

6.

What are the factors affecting response to diuretics?

7.

How can we overcome the diuretics resistance? 7a.

Effective doses of loop diuretics

7b.

Combined diuretic therapy

7c.

Intravenous administration of diuretics

7d.

Albumin infusions

7e.

Alternative methods of edema management

8.

Conclusion.

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