Reference no: EM133876202

Question

Shorten In nephrotic syndrome, disturbances in the glomerular basement membrane (GBM) and podocyte injury lead to loss of electrical negative charge and increased permeability (see Chapter 38). Loss of plasma proteins, particularly albumin and some immunoglobulins, occurs across the injured glomerular filtration membrane (Fig. 39.11). Loss of plasma proteins decreases plasma oncotic pressure, resulting in edema. The predominant cause of nephrotic syndrome is minimal change nephropathy, which is common in children (see Chapter 40). Hypoalbuminemia results from urinary loss of albumin combined with a diminished synthesis of replacement albumin by the liver. Albumin is lost in the greatest quantity because of its high plasma concentration and low molecular weight. Decreased dietary intake of protein from anorexia or malnutrition or accompanying liver disease may also contribute to lower levels of plasma albumin. Loss of albumin stimulates lipoprotein synthesis by the liver and hyperlipidemia and can promote progression of glomerular disease. Loss of immunoglobulins may increase susceptibility to infections. Sodium retention is common. Hypercoagulation results from alterations in coagulation factors, fibrinolysis, and platelet function.