NEPHROTIC 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 CausePathophysiologic 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

Cause of Proteinuria as Related to Quantity CauseDaily protein excretion Mild glomerulopathies Tubular proteinuria Overflow proteinuria 0.15 to 2.0 g Usually glomerular2.0 to 4.0 g Always glomerular>4.0 g

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