Overview of heavy proteinuria and the nephrotic syndrome.pdf
NEPHROTIC SYNDROME. Common Causes of Benign Proteinuria Dehydration Emotional stress Fever Heat...
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Transcript of NEPHROTIC SYNDROME. Common Causes of Benign Proteinuria Dehydration Emotional stress Fever Heat...
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NEPHROTIC SYNDROMENEPHROTIC 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
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
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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
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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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