Disease Information for Nephrotic syndrome: Definition

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  • Nephrotic Syndrome: twenty-four hour urine protein > three grams; May be associated with hypoalbuminemia and hypercholesterolemia; -----------------------------------------------Diagnosis:Urine protein excretion > 3_5 g/1_73 m2 per 24 hours; Hypoalbuminemia (albumin < 3 g/dL); Peripheral edema; In adults, about one-third of patients with nephrotic syndrome have a systemic renal disease such as diabetes mellitus, amyloidosis, or systemic lupus erythematosus; With the current epidemic of type 2 diabetes mellitus, this proportion is slowly increasing; The remainder have idiopathic nephrotic syndrome; The four most common are minimal change disease, focal glomerular sclerosis, membranous nephropathy, and membranoproliferative glomerulonephritis;Clinical Findings; Symptoms and Signs; Peripheral edema is a hallmark of the nephrotic syndrome, occurring when the serum albumin concentration is less than 3 g/dL Edema is most likely due to sodium retention (from renal disease) rather than arterial underfilling from low plasma oncotic pressure;Initially this presents in the dependent areas of the body such as the lower extremities; however, such edema can become generalized; Patients can experience dyspnea due to pulmonary edema, pleural effusions, and diaphragmatic compromise with ascites; Complaints of abdominal fullness may also be present in patients with ascites; Patients may show symptoms and signs of infection more frequently than the general population owing to loss of immunoglobulins and certain complement moieties in the urine; Urinalysis: Proteinuria occurs as a result of an alteration of the negative charge in the GBM; The screening test for proteinuria is the urinary dipstick analysis; however, one must bear in mind that this test indicates albumin only; The addition of sulfosalicylic acid to the urine sediment can detect the presence of abnormal paraproteins; Urine dipstick testing can detect as little as 15 mg/dL of protein, but the results must be interpreted along with the urine specific gravity; Trace protein seen on highly concentrated specimens may be insignificant, while trace protein on dilute specimens may indicate true renal disease; Microscopically, the urinary sediment has relatively few cellular elements or casts; However, if marked hyperlipidemia is present, patients can have oval fat bodies in the urine; These represent lipid deposits in sloughed renal tubular epithelial cells; They appear as "grape clusters" under light microscopy and "Maltese crosses" under polarized light; Blood chemistries; Characteristic blood chemistries include a decreased serum albumin (< 3 g/dL) and total serum protein < 6 g/dL; Hyperlipidemia occurs in over 50% of those with early nephrotic syndrome;

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