NEPHROTIC SYNDROME

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• NEPHROTIC SYNDROME

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

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Classification of Proteinuria Classification of Proteinuria Classification of Proteinuria
Cause Pathophysiologic features Type
Primary or secondary glomerulopathy Increased glomerular capillary permeability to protein Glomerular
Tubular or interstitial disease Decreased tubular reabsorption of proteins in glomerular filtrate Tubular
Monoclonal gammopathy, leukemia Increased production of low- molecular-weight proteins Overflow
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Cause of Proteinuria as Related to Quantity Cause of Proteinuria as Related to Quantity
Cause Daily protein excretion
Mild glomerulopathiesTubular proteinuriaOverflow proteinuria 0.15 to 2.0 g
Usually glomerular 2.0 to 4.0 g
Always glomerular gt4.0 g
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NEPHROTIC SYNDROME

• PROTEINURIA
• EDEMA
• HYPERLIPIDEMIA
• LIPIDURIA
• HYPERCOAGULABILITY

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CAUSES OF HYPERLIPIDEMIA

• INCREASED LIPOPROTEIN SYNTHESIS
• INCREASED LOSS OF REGULATOR PROTEINS
• DEFECTIVE LIPID CATABOLISM

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CAUSES OF HYPERCOAGULABILITY

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

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OTHER METABOLIC COMPLICATION

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

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POOR PROGNOSIS FACTORS IN MGN

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

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