Nephrotic syndrome
Nephrotic syndrome is a glomerular protein-leak state causing heavy proteinuria, hypoalbuminaemia and oedema, with important risks of thrombosis, infection, acute kidney injury and progressive kidney disease.
Definition
Nephrotic syndrome is a clinical syndrome of heavy proteinuria with hypoalbuminaemia and oedema caused by increased glomerular permeability. Hyperlipidaemia and a prothrombotic or infection-prone state are common associated features.
First principles
A damaged filtration barrier leaks protein
The glomerular endothelium, basement membrane and podocyte slit diaphragm normally retain albumin. Podocyte or glomerular injury increases permeability, causing heavy urinary protein loss. This is a nephrotic pattern; prominent haematuria, hypertension, active urine sediment or rapidly falling kidney function suggests an overlapping nephritic or rapidly progressive process.
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