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What are the clinical manifestations of nephrotic syndrome?

Aug 28, 2017

Nephrotic syndrome is the most basic feature of a large number of proteinuria, hypoproteinemia, (high) edema and hyperlipidemia, the so-called "three high and one low", and other metabolic disorders characterized by a group of clinical syndrome.

A large number of proteinuria: a large number of proteinuria NS patients is the most important clinical manifestations, nephrotic syndrome is the most basic pathophysiological mechanism. A large number of proteinuria refers to adult urine protein excretion> 3.5g / d. In normal physiological conditions, glomerular filtration membrane with molecular barrier and charge barrier, resulting in increased protein content in the original urine, when far more than the proximal tubule back to the amount of absorption, the formation of a large number of proteinuria. On this basis, where the increase in glomerular pressure and lead to high perfusion, high filtration factors (such as high blood pressure, high protein diet or a large number of infusion of plasma protein) can increase the discharge of urine protein.

Hypoproteinemia: plasma albumin down to <30g / L. NS is a large number of albumin lost from the urine, promote albumin liver compensatory synthesis and increased renal tubular decomposition. Low albuminemia occurs when liver albumin synthesis is not sufficient to overcome loss and breakdown. In addition, NS patients due to gastrointestinal mucosal edema caused by eating loss, lack of protein intake, poor absorption or loss, but also increase the causes of hypoalbuminemia.

In addition to plasma albumin reduction, some plasma immunoglobulin (such as IgG) and complement components, anticoagulant and fibrinolytic factors, metal binding protein and endocrine binding protein can also be reduced, especially a large number of proteinuria, glomerular Pathological damage is more severe and non-selective proteinuria is more significant. Patients prone to infection, hypercoagulable, lack of trace elements, endocrine disorders and immune dysfunction and other complications.

Edema: NS hypoalbuminemia, plasma colloid osmotic pressure decreased, so that water from the vascular cavity into the tissue gap, is the basic cause of NS edema. Recent studies have shown that about 50% of patients with normal or increased blood volume, plasma renin levels normal or decreased, suggesting that some of the primary renal sodium, water retention factors in the NS edema mechanism play a role.

Hyperlipidemia: The reason why NS is associated with hyperlipidemia is not yet fully elucidated. High cholesterol and / or hypertriglyceridemia, serum LDL, VLDL and lipoprotein (α) concentration increased, often associated with hypoproteinemia. Hypercholesterolemia is mainly due to increased liver lipoprotein production, but in the surrounding cycle to reduce the decomposition also play a part. Hypertriglyceridemia is mainly due to catabolic disorders caused by increased liver synthesis as a secondary factor.

What are the clinical manifestations of nephrotic syndrome?

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