Saturday, May 9, 2009

Pathophysology of nephrotic syndrome

Nephrotic syndrome is a clinical manifestation often results from renal disease that cause damage to the filtration barrier of golemerulus (GBM). The signs and symptoms are:
  • massive proteinuria ( >3.5 g/day)
  • hypoalbuminaemia ( plasma albumin <>
  • Generalised edema
  • Hyperlipidaemia
  • other minor symptoms and signs
Following massive injury to glomerular basement membrane, effacement of podocytes (of GBM) occurs and leads to increased permeability of GBM to large molecular weight substance, paticularly protein. Massive PROTEINURIA results. This will cause reduction in plasma protein level (HYPOALBUMINAEMIA). Reduced plasma oncotic pressure will make the fluid escape into interstitum and results in EDEMA.

Edema will cause reduction in circulating plasma volume. Reduced GFR takes place and cause activation of RAAS system. Water and sodium retention occurs and this will increase capillary hydrostatic pressure. More fluid escape into interstitium and further aggrevates the edema and cause GENERALISED EDEMA (ANASARCA). The cycles continue and OLIGURIA results.

Hypoalbuminaemia will stimulate increased liver production of lipoprotein. This will cause HYPERLIPIDAEMIA.



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