Triad of hypoalbuminemia, edema, nephrotic-range proteinuria (over 3.5g/24h)
Other components of the syndrome: hyperlipidemia, hypercoagulability, lipiduria (causing oval fat bodies seen above)
The primary problem in the nephrotic syndrome is urinary protein loss due to altered permeability of the glomerulus. Other manifestations are all secondary to protein loss.
Loss of albumin and consequent loss of oncotic pressure lead to the clinical manifestation of edema, which may be profound. Periorbital edema is sometimes more prominent in the nephrotic syndrome than other causes of edema.
Hyperlipidemia results from urinary loss of regulatory lipoproteins, and low oncotic pressure may increase hepatic lipogenesis
Hypercoagulability may be arterial or venous, and often involves the kidneys themselves (i.e. renal vein thrombosis). May result from urinary loss of proteins c and s, and possibly antithrombin III
Causes in adults:
Primary renal diseases:
Minimal change
Focal segmental glomerulosclerosis (FSGS)
Collapsing glomerulopathy
Membranous nephropathy
Membranoproliferative GN (MPGN)
IgA nephropathy
Systemic diseases:
Infectious: HBV, HCV, HIV, syphillis, schistosomiaisis, malaria
Inflammatory/rheumatologic: SLE, amyloidosis, cryoglobulinemia
Malignancy: solid tumors, primary hematologic malignancies (e.g. Hodgkin's lymphoma)
Others: Sickle cell disease, heroin, drugs (e.g. gold, penicillamine)
Therapy:
1) treat the underlying cause
2) measures to limit proteinuria- largely ACE-inhibitors and/or ARBs
3) measures to deal with complications- salt restriction, careful diuretic use (as may become easily intravascularly depleted), statins, vitamin D supplementation if deficient
Links:
Other components of the syndrome: hyperlipidemia, hypercoagulability, lipiduria (causing oval fat bodies seen above)
The primary problem in the nephrotic syndrome is urinary protein loss due to altered permeability of the glomerulus. Other manifestations are all secondary to protein loss.
Loss of albumin and consequent loss of oncotic pressure lead to the clinical manifestation of edema, which may be profound. Periorbital edema is sometimes more prominent in the nephrotic syndrome than other causes of edema.
Hyperlipidemia results from urinary loss of regulatory lipoproteins, and low oncotic pressure may increase hepatic lipogenesis
Hypercoagulability may be arterial or venous, and often involves the kidneys themselves (i.e. renal vein thrombosis). May result from urinary loss of proteins c and s, and possibly antithrombin III
Causes in adults:
Primary renal diseases:
Minimal change
Focal segmental glomerulosclerosis (FSGS)
Collapsing glomerulopathy
Membranous nephropathy
Membranoproliferative GN (MPGN)
IgA nephropathy
Systemic diseases:
Infectious: HBV, HCV, HIV, syphillis, schistosomiaisis, malaria
Inflammatory/rheumatologic: SLE, amyloidosis, cryoglobulinemia
Malignancy: solid tumors, primary hematologic malignancies (e.g. Hodgkin's lymphoma)
Others: Sickle cell disease, heroin, drugs (e.g. gold, penicillamine)
Therapy:
1) treat the underlying cause
2) measures to limit proteinuria- largely ACE-inhibitors and/or ARBs
3) measures to deal with complications- salt restriction, careful diuretic use (as may become easily intravascularly depleted), statins, vitamin D supplementation if deficient
Links:
Click here for a NEJM clinical case on nephrotic syndrome
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DeleteNEPHROTIC SYNDROME is a serious kidney disease that cannot be cured by drugs or injections, but the best way to get rid of nephrotic syndrome is to take a natural herbal medicine for it.
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