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Clinical manifestations of nephrotic syndrome

2017-03-01 11:34

NS is the most basic characteristic of proteinuria, hypoalbuminemia, edema (height) and hyperlipidemia, the so-called "three high and one low", and other metabolic disorders characterized by a group of clinical syndrome.

1 massive proteinuria

A large number of proteinuria is the most important clinical manifestations of NS patients, but also the most basic pathophysiological mechanism of nephrotic syndrome. A large number of proteinuria is the output of adult urinary protein >3.5g/d. Under normal physiological conditions, glomerular filtration membrane has a molecular barrier and a charge barrier, resulting in an increase in the content of protein in the urine. On this basis, 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 excretion of urinary protein.

2 hypoproteinemia

Plasma albumin decreased to <30g/L. At NS, a large amount of albumin was lost from the urine, which promoted the compensatory synthesis of hepatic albumin and increased the decomposition of renal tubule. When the increase in albumin synthesis in liver is not sufficient to overcome the loss and decomposition, hypoalbuminemia. In addition, NS patients due to gastrointestinal mucosal edema leading to poor appetite, insufficient protein intake, malabsorption or loss, also aggravate hypoproteinemia.

Besides the reduction of plasma albumin, some plasma immunoglobulin and complement components (such as IgG), anticoagulation and fibrinolytic factors, metal binding proteins and endocrine hormone binding protein can also be reduced, especially the large amount of proteinuria, glomerular pathological damage and non selective proteinuria is more significant. The patients were prone to complications such as infection, high coagulation, trace element deficiency, endocrine disturbance and low immune function.

3 edema

NS, hypoalbuminemia, plasma colloid osmotic pressure decreased, so that the water from the vascular cavity into the interstitial space, 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 are normal or decreased, suggesting that some of the original in the kidney sodium, water retention factors play a role in the pathogenesis of NS edema.

4 hyperlipidemia

The cause of NS complicated with hyperlipidemia is not fully elucidated. High cholesterol and (or) hypertriglyceridemia, elevated serum LDL, VLDL and lipoprotein (alpha) concentrations, often associated with hypoproteinemia. Hypercholesterolemia is mainly due to an increase in the synthesis of lipoproteins in the liver, but a decrease in the peripheral circulation is also part of the role. Hypertriglyceridemia is mainly due to the decomposition of metabolic disorders, liver synthesis increased as a secondary factor.


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