Post Date December, 03 2023
Common features of nephrotic syndrome. The number of kidney disease patients has been increasing in recent years, and the age of patients has shown a trend of youthfulness, which is a threat to many people. Today, the editor will introduce a common disease of kidney disease - nephrotic syndrome. What are the characteristics of this disease?
What are the common features of nephrotic syndrome.
1. A large amount of proteinuria A large amount of proteinuria is a sign of nephrotic syndrome. The main component is albumin, but also contains other plasma proteins. The change of glomerular basement membrane permeability is the basic cause of proteinuria. The change of charge barrier and mechanical barrier (glomerular capillary aperture barrier), the reabsorption and catabolism ability of renal tubular epithelial cells also affect the formation of proteinuria, and the glomerular filtration rate, Plasma protein concentration and protein intake directly affect the degree of proteinuria. When the glomerular filtration rate decreases, proteinuria will decrease; When severe hypoproteinemia occurs, urinary protein excretion can increase, while a high protein diet can increase urinary protein excretion; Therefore, using daily protein quantification alone cannot accurately determine the degree of urinary protein. Further studies can be conducted on albumin clearance rate, urinary protein/creatinine (>3.5 is often proteinuria within the range of kidney disease), and the detection of increased igg components in urine by urine protein electrophoresis indicates low urinary protein selectivity. Urinary protein selectivity has no definite clinical value and is now less commonly used.
2. Hypoalbuminemia is an essential second characteristic of nephrotic syndrome. When serum albumin is below 30g/l, the synthesis of white protein in the liver increases during nephrotic syndrome. When sufficient protein and heat are given in the diet, the liver of the patient synthesizes about 22.6g of albumin per day, which is significantly higher than 15.6g of normal people per day. Hypoalbuminemia only occurs when the compensatory effect of liver albumin synthesis is insufficient to compensate for the loss of urine protein, There is an inconsistency between hypoproteinemia and urinary protein excretion.
Patients with nephrotic syndrome usually have a negative Nitrogen balance, which can change to a positive Nitrogen balance when the protein load is high. The high protein load may increase the excretion of urinary protein due to the increase of glomerular filtration protein, so the increase of plasma protein is not obvious. However, taking angiotensin converting enzyme inhibitor at the same time can inhibit the excretion of urinary protein, and the serum albumin concentration can increase significantly.
It is worth noting that during hypoproteinemia, the binding of drugs to albumin decreases, and the concentration of free drugs in the blood increases, which may increase the toxicity of the drugs.
Multiple plasma protein components can undergo changes in nephrotic syndrome, α 2 and β Increased globulin content, α 1. Globulin is mostly normal, with a significant decrease in igg levels, while iga, igm, and ige levels are mostly normal or elevated. Fibrinogen, coagulation factors V, VII, VIII, X can increase, which may be related to increased liver synthesis, accompanied by an increase in platelet count, a decrease in antithrombin III (heparin related factor), and a normal or elevated concentration of c and s proteins, but with a decrease in activity, all of which can contribute to the occurrence of hypercoagulability, The increase in fibrinolytic products (fdp) in urine reflects changes in glomerular permeability. In summary, various pre factors of coagulation and coagulation in the blood are increased, while the mechanisms of anti coagulation and fibrinolysis are impaired. Due to the combined effects of hypercholesterolemia and high fibrinogenemia, plasma viscosity increases, and spontaneous thrombosis is prone to occur when the vascular endothelium is damaged.
In addition, transport proteins also decrease, such as proteins carrying important metal ions (copper, iron, zinc), and proteins binding to important hormones (thyroxine, corticosteroids, prostaglandins) and active 25- (oh) d3. The latter can lead to secondary hyperparathyroidism, disrupted calcium and phosphorus metabolism, renal bone disease, and sustained decrease in transferrin, Changes in the ratio of hormones that free and bind glucocorticoids in the treated patient's body lead to changes in the metabolism and efficacy of the drug.
3. Hyperlipidemia The total cholesterol and triacylglycerol of the disease increased significantly, and the levels of low-density lipoprotein (ldh) and very low-density lipoprotein (vldh) increased. Hyperlipidemia was related to hypoalbuminemia. The ldl/hldl only increased when the serum albumin was lower than 10-20g/l. high-density lipoprotein (hdl) was normal or decreased, and the ldl/hdl ratio increased, which increased the risk of arteriosclerotic complications, Hyperlipidemia is associated with thrombosis and progressive glomerulosclerosis.
The patient may present with lipiduria, and there may be double refracted fat bodies in the urine, which may be epithelial cells containing cholesterol or fat body tubules.
What are the characteristics of nephrotic syndrome mentioned above? The above is all the introduction for you. For this disease that can directly cause huge harm to your life, we suggest that you seek timely consultation from hospitals and experts regarding your condition. If you have any problems, seeking medical attention in a timely manner is a responsible attitude towards yourself!
