Clinically, the experts from Shijiazhuang Kidney Disease Hospital believe
that there are four main features of Nephrotic Syndrome: massive Proteinuria,
Hypoproteinemia, Hypercholesterolemia and Edema in the whole body.
1. Massive proteinuria.
It is the symbol of Nephrotic Syndrome. It mainly includes albumin and other
plasma protein elements as well. The permeability change of glemerular basement
membrane is the fundamental cause of proteinuria, in addition, the change of
charge barrier and mechanical barrier (the barrier of glomerular capillary
aperture) and the ability of reabsorption and catabolism of renal tubular
epithelial cells can also affect the forming of proteinuria. Glomerular
filtration rate, the concentration of plasma protein and the protein intake can
directly affect the degree of proteinuria. When glomerular filtration decreases,
the proteinuria will decrease; when severe Hypoproteinemia occurs, the excretion
of urine protein will rise and the high-protein diet can also drive it up. Thus,
it is improper and inexact to diagnose the degree of proteinuria only by testing
the quantity like protein every day, so to judge it, some further examinations
of albumin clearance rate and urine protein/creatinine (>3.5 means
proteinuria within the scale of kidney disease) should be done.
2. Hypoproteinemia
It is the second characteristic of Nephrotic Syndrome. It means that the
concentration of serum albumin is under 30g/L. When someone suffers from
Nephrotic Syndrome, their livers will compound more albumins, and when the food
includes enough protein and calories, their livers will roughly compound 22.6g
of albumin per day which is much more than 15.6g of ordinary people. When the
albumin compounded by liver can not make up the loss of urine protein,
Hypoproteinemia will occur.
Patients with Nephrotic Syndrome always have negative nitrogen balance, and
when high protein is loaded, the negative nitrogen balance can be converted into
positive. Loaded high protein may make the excretion of urine protein go up due
to the increase of filtered protein of glomerulus, so the increase of plasma
protein concentration is not obvious and meanwhile taking angiotensin-converting
enzyme inhibitors can inhibit the excretion of urine protein, which can lead to
the distinct growth of blood albumin concentration.
There is one thing which should be emphasized, that is when Hypoproteinemia
occurs, the combination of medicine and albumin will decrease and the
concentration of free medicine in blood will go up, which may result in the
toxic reaction of the medicine.
3. Hyperlipidemia
In the case of Hyperlipidemia, the total cholesterol and triglycerides
increase obviously, and the level of Low-Density Lipoprotein and
Very-Low-Density Lipoprotein will increase too. Hyperlipidemia is closely
related to Hypoalbuminemia, and LDL/HLDL increase only when the concentration of
serum albumin drops under 10—20g/L while High-Density Lipoprotein keeps normal
or decreases. The increase of LDL/HDL will increase the risk of
Arteriosclerosis. Hyperlipidemia patients present lipid urine with
double-refraction fat bodies, which may be epithelial cells or fat-body casts
that including cholesterol.
4. Edema
For patients, the most notable symptom is the worsening Anasarca. At the
beginning, swelling can occur in eyelids, face and ankles in the morning. With
the development of the disease, swelling will spread to the whole body, together
with the occurrence of Pleural Effusion, Ascites, Pericardial Effusion,
Mediastinal Effusion, swelling in scrotum or labia and sometimes Pulmonary Edema
appears as well. Patients with severe Edema can hardly open their eyes and their
heads and necks will become thicker together with waxy-pale skin, hydrothorax
and ascites, as a result, they suffer from difficult breathing and they can only
keep sitting up. The degree of severity is related to Hypoalbuminemia, which is
possitive correlation. For more information, please Email us at khkpcn@hotmail.com