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Nephrotic Syndrome

Nerd-frog
Picmonic
Nephrotic syndrome is a group of symptoms including massive proteinuria defined as a daily loss of 3.5 gm or more of protein, hyperlipidemia, generalized edema, and hypoalbuminemia which results from renal pathology.  Nephrotic syndrome is caused by several diseases including membranous glomerulonephritis, minimal change disease, and focal segmental glomerulosclerosis.  Nephrotic syndrome is usually initially related to a derangement in the glomerular capillary walls that result in increased permeability to plasma proteins. Loss of protein leads to hypoalbuminemia beyond the compensatory rate of synthesis in the liver, which contributes to generalized edema due to decreased colloid osmotic pressure in the blood. Additionally, nephrotic syndromes are often characterized by immunodeficiency due to loss of immunoglobulins and thrombotic complications due to loss of anticoagulants like antithrombin, protein C and protein S in the urine. 
6 KEY FACTS
SIGNS AND SYMPTOMS
Massive Proteinuria > 3.5g per Day
Massive Protein-urinal on Top of (3) Tree with 0.5 tag

Massive proteinuria greater than 3.5g per day is the hallmark sign of nephrotic syndrome disease processes. Massive proteinuria is caused by derangement in the glomerular capillary walls that result in increased permeability to plasma proteins.

Edema
Edamame

Edema is swelling of the face, lower extremities, and hands due to loss of oncotic pressure within the blood because of lost protein.

Increased risk of infection
Viruses and Bacteria

Increased risk of infection can result due to decreased immunoglobulin levels due to protein losses in the urine.

Thromboembolism
Trombone-Elmo

Patients with nephrotic syndrome are hypercoagulable, making them more prone to developing a thromboembolism. This occurs from proteinuria, where patients lose protein C and protein S in the urine, along with antithrombin. Futhermore, because albumin is lost in the urine, there is decreased binding of plasminogen to fibrin, which leads to impaired fibrinolysis. Albumin losses also lead to increased availability of thromboxane A2 (which is normally bound to albumin), causing platelets to aggregate.

Hyperlipidemia
Hiker-lips

Hyperlipidemia is also an important component, thought to be caused by increased synthesis of lipoproteins in the liver.

Fatty casts
Fat-guy in a Cast

Fatty casts are groups of lipid-rich epithelial cells, formed due to elevated lipid levels, which are trapped in the kidney and are seen on microscopic urinalysis.

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