Nephrotic Syndrome

In a nutshell

Podocyte injury abolishes the size-selective filtration barrier, causing heavy proteinuria. Falling albumin drops oncotic pressure and causes oedema, while the liver's compensatory protein synthesis raises lipids and the same protein leak causes a prothrombotic, infection-prone state: one cascade from one lesion.

Classic presentation

A child or adult with rapidly developing generalised oedema (periorbital on waking, dependent later) and frothy urine, with heavy proteinuria and low serum albumin on testing.

Key points

• 1The triad of proteinuria, hypoalbuminaemia and oedema is one cascade from a single lesion at the filtration barrier, not three separate findings.