SINDROM NEFROTIK

Referat Samuel Marco 0710160 Melisa C

 Nephrotic syndrome is kidney disease with proteinuria, hypoalbuminemia and edema. Nephrotic range proteinuria is 3 grams/day or more On single spot urine collection, it is 2 g of protein per gram of urine creatinine

etiology
Common primary causes of nephrotic syndrome include kidney disease such as:
Minimal-change nephropaty Menbranous nephropathy Focal glomerulosclerosis

Cont
Secondary causes include systemic disease such as:
Diabetes mellitus Lupus erythematous Amyloidosis Congenital and hereditary focal glomerulosclerosis Drugs abuse such as heroin Medication can cause nephrotic syndrome : NSAID (MCN) and administration of older drugs of rheumatic (MN)

 Nephrotic range proteinuria could occur with the use of Anticancer agent such as bevacizumab that inhibit vasculat endothelial growth factor (VEGF) NRP occuring in the 3rd trimester of pregnancy is the clasical finding of preeclampsia, hypertension develops as well

epidemiology
United states statistics Diabetic nephropathy with nephrotic syndrome is most common, at an estimated rate of at least 50 case/ million population In children, nephrotic syndrome may occur at a rate of 20 cases per million children

Race-, sex-, and age related demographics

Because diabetes is major cause of nephrotic syndrome, american indians, hispanic, and african amaerican have higher incidence of NS tha white persons HIV nephropathy as complication of HIV infection is unusual in whites; it is seen greater frequency in african american Focal glomerulosclerosis appears to be overrepresented in african american children than white children

 Male predominance in the occurance of nephrotic syndrome However, lupus nephritis affects mostly women

pathogenesis
An increase in glomerular permeability leads to albuminuria and eventually to hypoalbuminemia. Hypoalbuminemia lowers the plasma colloid osmotic pressure, causing greater transcapillary filtration of water throughout the body and thus the development of edema With high capillary hydrostatic pressure or a low intravascular oncotic pressure, edema occurs

Metabolic consequences of proteinuria

Infection Hyperlipidemia and atherosclerosis Hypocalcemia and bone abnromalities Hypercoagulability Hypovolemia Hypertension (related to fluid retention and reduced kidney funtion) Malnutrition ( anorexia, infectious complication, edema of the gut cause defective absorption) -> failure to thrive

infection
Urinary immunoglobulin losses Edema fluid acting as a culture medium Protein deficiency Immunosuppressive therapy Decreased perfusion of the spleen

hyperlipidemia
Related with hypoproteinemia and low serum oncotic pressure of nephrotic syndrome which then leads to reactive hepatic protein synthesis, including lipoprotein Elevated lipoprotein are filtered at the glomerulus leading to lipiduria

hypocalcemia
Its not a true hypocalcemia, but caused by low serum albumin level. Low bone density and abnormal bone caused by urinary losses of vitamin D and reduced intestinal calcium absorption But it is possible that long duration of either nephrotic syndrome or treatments (prednisone) are the important risk factor for bone disease

hypercoagulability
Venous thrombosis and pulmonary embolism are complications of the NS. This can appear from urinary loss of antikoagulant proteins, such as :
Antithrombin III Plasminogen Along with the simultaneous increase in clotting factors : factors I, VII, VIII and X VTE at NS 10 times higher than normal people

Permeabilitas glomerulus meningkat

Kebocoran protein bound hormone/ Kalsium

Kenaikan filtrasi plasma protein (albumin)

LIPIDURIA

Penurunan Ca plasama dan T4

ALBUMINURIA

HIPERLIPOPROTEINEMIA

Kenaikan sintesa protein di hepar Kenaikan reabsorpsi plasma protein HIPOALBUMINEMIA Penurunan volume intra vaskular Katabolisme albumin dalam sel tubulus Malnutrisi dan protein losing enteropathy Retensi Natrium dan air

Kerusakan sel tubulus menyebabkan aminoasiduria

oedem

Kenaikan volume cairan interstisial

SINDROM NEFROTIK Proteinuria masif hipoalbuminemia tekanan onkotik kapiler

Factor Humoral

VDE
aktivasi simpatetik dan katekolamin renin-angiotensin

tahanan vascular ginjal

desakan starling dan kapiler peritubular

aktivasi aldosteron

resorpsi Na dalam tubular

LFG
NATRIURESIS

Volume cairan ekstra selular

Sembap/oedem