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4 main features of nephrotic syndrome

Dec 29, 2016
There are 4 main characteristics of nephrotic syndrome, that is, proteinuria, hypoproteinemia, hypercholesterolemia, and systemic edema.
1 massive proteinuria: massive proteinuria is a sign of nephrotic syndrome. The main component is albumin, also contains other plasma protein components. Changes in the permeability of the glomerular basement membrane is a primary cause of proteinuria and charge barrier and mechanical barrier (glomerular capillary pore barrier) changes also affect the renal tubular epithelial cell uptake and catabolism ability on the formation of proteinuria. Glomerular filtration rate, plasma protein concentration and protein intake directly affect the degree of proteinuria. Reduced glomerular filtration rate, proteinuria will reduce; severe hypoproteinemia, urinary protein excretion increased, high protein diet will increase the excretion of urinary protein; therefore, only the method of quantitative protein every day, can not accurately judge the degree of proteinuria, but further albumin clearance rate, urinary protein / creatinine (>3.5 often nephrotic range proteinuria). The detection of IgG in urine increased with urine protein electrophoresis, which indicated that the selectivity of urinary protein was low. The clinical value of urinary protein selectivity has not been confirmed and is now used less.
2 hypoproteinemia: nephrotic syndrome is an essential feature of the second. Serum albumin was lower than 30g/L. Nephrotic syndrome increased synthesis of albumin in liver syndrome, when given enough protein and calories in the diet, the liver synthesis of albumin in patients with about 22.6g per day, significantly increased than normal 15.6g every day. When the compensatory effect of liver albumin is insufficient to compensate for the loss of urinary protein, hypoproteinemia will occur. There was no consistent relationship between hypoproteinemia and urinary protein excretion.
1), patients with nephrotic syndrome is usually negative nitrogen balance, high protein load, can be transformed into positive nitrogen balance, high protein load may make urine protein increased due to the increase of glomerular filtration protein, the plasma protein did not increase significantly, but at the same time taking blood angiotensin converting enzyme inhibitor, can inhibit urinary protein excretion, serum albumin concentration increased significantly.
2, it is worth noting that, when hypoproteinemia, the combination of drugs and albumin will be reduced, the blood concentration of free drugs, may increase the toxicity of drugs.
3, nephrotic syndrome, a variety of plasma protein components can be changed, alpha 2 and beta globulin increased, alpha globulin more normal 1. The level of IgG was significantly decreased, while IgA, IgM and IgE levels in normal or increased, fibrinogen and coagulation factor V, VII and VIII, X can be increased, and increased hepatic synthesis may, with the increase in the number of platelets, antithrombin III (heparin related factor) decreased, C protein and S protein concentration than normal or increased, but the activity decreased. This will contribute to the occurrence of hypercoagulable state. The increase of fibrin degradation product (FDP) in urine reflects the change of glomerular permeability. In a word, the various factors of coagulation and agglutination were increased, but the mechanism of anti coagulation and fibrinolysis was impaired. Due to the combined effects of hypercholesterolemia and fibrinogen, plasma viscosity increases, and when the endothelium is damaged, it is easy to produce spontaneous thrombosis.
4), in addition, transporter is also reduced, such as carrying important metal ions (Cu, Fe, Zn) protein decreased, and the most important hormones (thyroxine, cortisol, prostaglandins) and active 25- (OH) D3 binding protein also decreased, which may result in secondary parathyroidism. The metabolism of calcium and phosphorus, lead to renal osteodystrophy. The decrease in the number of transferrin leads to a change in the ratio of free and bound hormones in glucocorticoid treated patients.
3 the total cholesterol, the level of three acyl glycerol and the low density lipoprotein (LDH) and very low density lipoprotein (VLDH) increased significantly in hyperlipidemia. Hyperlipidemia is associated with hypoalbuminemia, LDL/HLDL is only increased when serum albumin is below 10 ~ 20g/L. High density lipoprotein (HDL) normal or decreased. Elevated LDL/HDL ratio increases the risk of arteriosclerotic complications, and hyperlipidemia is associated with thrombosis and progressive glomerulosclerosis. The patients showed urinary lipid, fatty body double refraction in urine, possibly for epithelial cells or fat body tube containing cholesterol.
4 patients with edema most noticeable symptoms are progressive systemic edema, initial morning eyelid, face and ankle edema; with the progression of the disease and systemic edema, ascites, pleural effusion, pericardial effusion, mediastinal effusion, edema of scrotum or labia, also can appear pulmonary edema. Serious person can't open eyes, head and neck skin is thick, waxy pallor, and chest, ascites, so obvious breathing difficulties, not only sitting supine. If there is skin damage, the tissue fluid overflow and not easy to stop. Edema and body position is obvious, such as the appearance of edema, and should not be associated with venous thrombosis. The severity of edema was positively correlated with the degree of hypoalbuminemia. It is generally believed that the edema is caused by a large number of proteinuria caused by the decline of plasma proteins (especially albumin), the decrease of plasma colloid osmotic pressure, and the movement of water into the interstitial space. Otherwise that the syndrome edema associated with primary renal sodium and water retention, the possible factors are: the glomerular filtration rate decreased; the increased renal tubular reabsorption; the distal tubule of plasma atrial natriuretic peptide (ANP) reaction ability.

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