Overview of heavy proteinuria and the nephrotic syndrome

Heavy proteinuria is a common symptom of kidney disease,and we should learn some knowledges about this disease.

Focal nephritic – Disorders resulting in a focal nephritic sediment are generally associated with inflammatory lesions in less than one-half of glomeruli on light microscopy. The urinalysis reveals red cells (which often have a dysmorphic appearance), occasionally red cell casts, and mild proteinuria (usually less than 1.5 g/day). The findings of more advanced disease are usually absent, such as heavy proteinuria, edema, hypertension, and renal insufficiency. These patients often present with asymptomatic hematuria and proteinuria discovered on routine examination or, occasionally, with episodes of gross hematuria.
Diffuse nephritic – The urinalysis in diffuse glomerulonephritis is similar to focal disease, but heavy proteinuria (which may be in the nephrotic range), edema, hypertension, and/or renal insufficiency may be observed. Diffuse glomerulonephritis affects most or all of the glomeruli.
Nephrotic – The nephrotic sediment is associated with heavy proteinuria and lipiduria, but few cells or casts. The term nephrotic syndrome refers to a distinct constellation of clinical and laboratory features of renal disease. It is specifically defined by the presence of heavy proteinuria (protein excretion greater than 3.5 g/24 hours), hypoalbuminemia (less than 3.0 g/dL), and peripheral edema. Hyperlipidemia and thrombotic disease are also frequently observed.
Isolated heavy proteinuria without edema or other features of the nephrotic syndrome is suggestive of a glomerulopathy (with the same etiologies as the nephrotic syndrome), but is not necessarily associated with the multiple clinical and management problems characteristic of the nephrotic syndrome. This is an important clinical distinction because heavy proteinuria in patients without edema or hypoalbuminemia is more likely to be due to secondary focal segmental glomerulosclerosis (due, for example, to diabetes) [1].
This topic review will provide an overview of heavy proteinuria and the nephrotic syndrome, with emphasis on those disorders with a nephrotic presentation (ie, bland rather than active urine sediment). More specific issues relating to complications of the nephrotic syndrome are presented elsewhere. (See"Pathophysiology and treatment of edema in patients with the nephrotic syndrome" and "Renal vein thrombosis and hypercoagulable state in nephrotic syndrome" and "Endocrine dysfunction in the nephrotic syndrome" and "Lipid abnormalities in nephrotic syndrome" and "Acute kidney injury (acute renal failure) in minimal change disease and other forms of nephrotic syndrome".)

The individual disorders that cause the nephrotic syndrome are discussed in detail in separate topic reviews. Readers will be referred to these individual topics where appropriate.

Treatment

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