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Editorial
. 2022 Mar;17(1):153-168.
doi: 10.26574/maedica.2022.17.1.153.

Nephrotic Syndrome Complications - New and Old. Part 1

Ruxandra Mihaela Busuioc  1 , Gabriel Mircescu  1
Affiliations
Editorial

Nephrotic Syndrome Complications - New and Old. Part 1

Ruxandra Mihaela Busuioc et al. Maedica (Bucur). 2022 Mar.

Abstract

Nephrotic syndrome is a rare condition with an incidence of 2-7 cases/100.000 children per year and three new cases/100.000 adults per year. It occurs as a result of severe alteration of the glomerular filtration barrier of various causes, allowing proteins, mostly albumin, to be lost in the urine. Nephrotic syndrome complications are driven by the magnitude of either proteinuria or hypoalbuminemia, or both. Their frequency and severity vary with proteinuria and serum albumin level. Besides albumin, many other proteins are lost in urine. Therefore, nephrotic patients could have low levels of binding proteins for ions, vitamins, hormones, lipoproteins, coagulation factors. The liver tries to counterbalance these losses and will increase the unselective synthesis of all types of proteins. All of these changes will have different clinical consequences. The present paper aims to discuss the pathophysiological mechanism and new therapeutic recommendations for nephrotic syndrome edema and thromboembolic complications.

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Figures

FIGURE 1.
FIGURE 1.
Underfill and overfill hypothesis of nephrotic edema. ANP=atrial natriuretic peptide; AVP=arginine vasopressin; BP=blood pressure; ENaC=epithelial natrium channel; NE=norepinephrine
TABLE 1.
TABLE 1.
Factors which help to differentiate overfill from underfill nephrotic edema [adapted from (14)]
FIGURE 2.
FIGURE 2.
Sodium reabsorption along the nephron (percent) and diuretic site of action. ENaC: amiloride-sensitive epithelial sodium channel; Na/K/2Cl: bumetanide-sensitive sodium-potassium-chloride channel; NCC: thiazide-sensitive Na/Cl cotransporter
TABLE 2.
TABLE 2.
Clinical pharmacology of diuretics usually used in nephrotic edema
TABLE 3.
TABLE 3.
Therapy of nephrotic edema
TABLE 4.
TABLE 4.
Refractory nephrotic edema – causes and solutions
FIGURE 3.
FIGURE 3.
The mechanism of thromboembolism in NS is due to the combination of many factors, with podocyte injury playing a central role
FIGURE 4.
FIGURE 4.
Algorithm for anticoagulant therapy in nephrotic syndrome – adapted after (62). DOACs=direct-acting oral anticoagulants; HAS-BLED=hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly (> 65 years) score; LMWHs=low molecular weight heparins; sAlb=serum albumin
TABLE 5.
TABLE 5.
Factors associated with venous thromboembolic events in nephrotic syndrome (65)
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References

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