Clinical manifestations of nephrotic syndrome

Clinical manifestations of nephrotic syndrome

A large number of proteinuria
A large number of proteinuria is the most important clinical manifestations of NS patients, nephrotic syndrome is the most basic pathophysiological mechanisms. A large number of proteinuria is adult urinary protein excretion> 3.5g / d. Under normal physiological conditions, glomerular filtration membrane with a molecular barrier and charge barrier, resulting in the original urine protein content increased, when far more than the amount of the proximal tubule absorption, the formation of large amounts of proteinuria. On this basis, any increase in glomerular pressure and lead to high perfusion, high filtration factors (such as high blood pressure, high protein diet or large infusion of plasma protein) can increase the excretion of urinary protein.
2. Hypoproteinemia
Plasma albumin decreased to <30g / L. NS large albumin lost from the urine, and promote the compensatory synthesis of albumin liver and renal tubular decomposition increased. Hypoalbuminemia occurs when an increase in liver albumin synthesis is not sufficient to overcome loss and breakdown. In addition, NS patients with gastrointestinal mucosal edema caused by eating loss, inadequate protein intake, malabsorption or loss, but also increase the cause of hypoalbuminemia.
In addition to plasma albumin reduction, the plasma of certain immunoglobulin (such as IgG) and complement components, anticoagulant and fibrinolytic factors, metal binding protein and endocrine-binding protein can also be reduced, especially large amounts of proteinuria, glomerular Severe pathological damage and non-selective proteinuria is more significant. Patients prone to infection, hypercoagulability, trace element deficiency, endocrine disorders and immune dysfunction and other complications.
3. Edema
NS hypoalbuminemia, decreased plasma colloid osmotic pressure, so that water from the vascular cavity into the tissue 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 normal or decreased, suggesting that some of the primary intrarenal sodium, water retention factors in NS play a role in the mechanism of edema.
4. Hyperlipidemia
The cause of NS with hyperlipidemia has not been fully elucidated. High cholesterol and / or hypertriglyceridemia, serum LDL, VLDL and lipoprotein (α) concentration increased, often co-exist with hypoalbuminemia. Hypercholesterolemia is mainly due to increased synthesis of lipoproteins in the liver, but in the reduction of the surrounding circulation also play a part. Hypertriglyceridemia is mainly due to catabolic disorders caused by increased liver synthesis as a secondary factor.