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Wednesday, 20 October 2010 18:13 |
- Protein & albumin are filtered by the glomerulus.
- The high concentration of albumin in the blood results in albumin appearing in the ultrafilterate.
- Most albumin is reabsorbed & catalyzed in the proximal tubules. A small amount of albumin found in the urine of healthy children.
- The glomerular capillary wall normally possesses a net negative electrical charge & narrow pores that serve as barriers preventing the passage of the protein into the urine.
- In nephrotic syndrome these barriers are altered depending on the severity & nature of the underlying disease process.
- Clinically the development of edema has been explained by the massive losses of plasma proteins (particularly albumin) in the urine with the consequent development of hypoalbuminemia. This in turn leads to decrease plasma oncotic pressure & leakage of fluid from vascular space into interstitium. The drop in the circulating blood volume stimulate renin-angiotensin-aldosterone system leading to sodium retention.
- Nephrotic syndrome defined as heavy proteinuria (mainly albumin >1g/m2/24hr), hypoalbuminemia (<2.5g/dL) & edema with or without hyperlipidemia (>250mg/dL).
- Primary nephrotic syndrome in children typically presented with:
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