NEPHROTIC SYNDROMENEPHROTIC SYNDROME

• Common Causes of Benign Proteinuria Dehydration Emotional stress Fever Heat injury Inflammatory process Intense activity Most acute illnesses Orthostatic (postural) disorder

Classification of Proteinuria

TypePathophysiologic features

Cause

GlomerularIncreased glomerular capillary permeability to protein

Primary or secondary glomerulopathy

TubularDecreased tubular reabsorption of proteins in glomerular filtrate

Tubular or interstitial disease

OverflowIncreased production of low- molecular-weight proteins

Monoclonal gammopathy, leukemia

Cause of Proteinuria as Related to Quantity

Daily protein excretionCause

0.15 to 2.0 gMild glomerulopathiesTubular proteinuriaOverflow proteinuria

2.0 to 4.0 gUsually glomerular

>4.0 gAlways glomerular

NEPHROTIC SYNDROME• PROTEINURIA• EDEMA• HYPERLIPIDEMIA• LIPIDURIA• HYPERCOAGULABILITY

CAUSES OF HYPERLIPIDEMIA

• INCREASED LIPOPROTEIN SYNTHESIS

• INCREASED LOSS OF REGULATOR PROTEINS

• DEFECTIVE LIPID CATABOLISM

CAUSES OF HYPERCOAGULABILITY

• DECREASED ANTITHROMBIN III• DECREASED PROTEIN S & C• HYPERFIBRINOGENEMIA• ICREASED PLATELET

AGGREGABILITY

OTHER METABOLIC COMPLICATION

• PROTEIN MALNUTRITION• ANEMIA• HYPOCALCEMIA• DECREASED THYROXINE LEVEL• SUSCEPTIBILITY TO INFECTION

POOR PROGNOSIS FACTORS IN MGN

• MALE SEX• HYPERTENSION• DECREASED GFR• OLD AGE• SEVERE PROTEINURIA• SEVERE HYPERLIPIDEMIA