NEPHROTIC SYNDROME A.

Etiology and Incidence Also called Nephrosis It is not a disease in itself, but it results from a glomerular defect and may indicate renal damage. When we say glomerular defect, we mean defect on the filtration area of a nephron. Characteristics of Nephrotic Syndrome are the following: 1. Proteinuria - marked increase in protein in the urine 2. Hypoalbuminemia Decreases in albumin in the blood 3. Edema 4. Hyperlipidemia - High serum cholesterol and low-density lipoproteins It is apparent in any condition that seriously damages the glomerular capillary membrane and results in increased glomerular permeability

B. Pathophysiology Anatomy Understanding the anatomy of the urinary system is important in determining the affected site of any disease. Kidneys are pair of brownish-red structures retroperitoneally. It consists of two regions: 1. Renal parenchyma - has to parts: a. Cortex, which contains the glomeruli, proximal and distal tubules, and cortical collecting ducts; b. Medulla, which resembles pyramids situated with the base facing the concave surface of the kidney. 2. Renal Pelvis the concave portions of the kidney through which the renal artery enters and the renal vein exits. Renal artery divides into smaller and smaller vessels, eventually forming branches of glomerulus which is responsible for filtration and that which is commonly affected in nephritic syndrome. Glomerulus filters various substances. Normally, glomerulus receives blood from the afferent arteriole. Then, filtration occurs. Because of filtration, two things can happen: 1. Waste products are excreted 2. Electrolytes are maintained. Pathophysiology Where does nephritic syndrome start? Nephrotic syndrome occurs with almost any intrinsic disease or systemic disease that affects the glomerulus. These diseases include glomerulonephritis (inflammation of the glomerular capillaries), diabetes mellitus with intercapillary glomerulosclerosis (incomplete emptying of the bladder). It starts with a damaged glomerulus, particularly the capillary membrane. Glomerular filtration becomes impaired allowing serum proteins to escape into the urine (proteinuria). Consequently, this leads to two effects: 1. It stimulates synthesis or production of lipoproteins in an effort to compensate lost protein leading to hyperlipidemia (increased serum cholesterol and low-density lipoproteins 2. Hypoalbuminemia (decreased protein)

Decreased protein triggers reduced intravascular pressure. Less pressure also allows fluid to escape into the interstitial spaces. Interstitial pertains to gaps and spaces in any organ or structure resulting to edema. Signs and Symptoms 1. Edema - the major manifestation of nephritic syndrome. Usually, soft and pitting and most commonly seen: a. around the eyes (periorbital) b. in dependent areas (sacrum, ankles, hands) c. in the abdomen (ascites)

2. 3. 4. 5. 6.

Malaise Headache Irritability Fatiguee Orthostatic hypotension