The Pathogenesis and Complications of Nephropathy Syndrome

• Nephropathy Syndrome(NS) is a noun of diagnostics of symptoms, instead of an independent disease. The diagnosis of NS should include the following four items: large protein in urine(>3.5g/24h); hypoproteinemia (seralbumin<30g); obvious edema; hyperlipidaemia. Among the four mentioned items, the first two are essential conditions. The manifestations of NS are likely to appear in such diseases as various primary glomerular diseases and secondary renal diseases. So, NS could only used as a noun of diagnostics of symptoms, instead of a final diagnosis. When there are some manifestations of NS in clinical but without a definite pathogeny, “NS” could be diagnosed as temporarily, but try hard to make certain its specific reasons or pathological diagnosis.

  Etiology and Pathogenesis

  All various kinds of primary glomerular disease, could possibly have the clinical manifestations of NS, among which, minimal change nephropathy(lipoid nephrosis) is the most common one, followed by some pathological categories in acute and chronic nephritis. NS could also appear in various secondary renal diseases, such as lupus nephritis, diabetic nephropathy, lymphoma and some entity neoplastic renal diseases, etc. The main pathogenesis for NS lies in the increase of permeability on glomerular filtration membrane for the plasma protein, thus leads large protein into the urine, if this speed exceeds the reabsorption of renal tubules, large protein would be excreted out of the body together with urine. The loss of large plasma proteins would boost the rapid synthesis of protein, gradually, the overloading operations of liver could still cannot satisfy the need, so hypoproteinemia could appear in clinical. As a result of the decline in plasma oncotic pressure, water would effuse from the blood vessels, together with kidney’s disorder in adjusting the water and electrolyte, the edema would occur in clinical. The change of permeability on glomerulus filatrion membrane is connected with its original disease and pathological type. As for the minimal change nephropathy, the mainly manifestation is the destroy of charge barrier on glomerulus filtration membrane, which leads to the increase of permeability and the excretion of large albumin, this case is called “selective proteinuria”;other types of pathological changes could make the organization structure of glomerulus filtration membrane destroyed, except for albumin, all other macromolecular plasma proteins could be filtrated and excreted with urine, and this case is called “nonselective proteinuria”.

  Complications

  Infection. As a result of the loss of large protein and the reduce of immune globulin, together with the application of drugs such as hormones, the patients could easily be complicated by various kinds of infections, such as respiratory infections, urinary infections, skin infections, and even sepsis and peritonitis, etc. Yet, during the process of the application of glucocorticoid, the symptom of complicated infection is not typical, so this case is easily to be neglected, which would influence the prognosis.

  Hypercoagulability. Since the pachemia presents a state of hypercoagulability, so the vascular thrombosis could be easily formed, such as phlebothrombosis, lower extremity phebothrombosis, even involving in coronary vessels and pulmonary vessels for the severe cases. When the renal venous thrombosis is formed, the patients often have sudden lumbago, large protein, Hematuresis, renal impairment, etc. Yet, there are other patients with the gradual onset of the disease.

  Acute Renal Failure. With abundant liquid’s entering into the tissue spaces and decreasing in blood volume, so renal ischemia would be formed, or with such reasons as the formulation of the renal venous thrombosis, the drop of glomerulus filtration rate would be resulted, which would develop into the acute renal failure. 

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