What is the role of the glomerular basement membrane (GBM) in the pathophysiology of proteinuria?

Updated: Mar 25, 2020
  • Author: Beje Thomas, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

The GBM is made up of type IV collage, laminin, nidogen/entactin, sulfated proteoglycans, and glycoproteins. The GBM limits fluid movement. Changes in the proteins that make up the GBM, leading to proteinuria, have been described in congenital and acquired nephrotic syndrome. Proteinuria itself can cause endothelial damage: protein-mediated cytotoxicity may result in podocyte loss, leading to the production of chemokines and cytokines that initiate an inflammatory response. The end point is sclerosis and fibrosis of the glomerulus [9]

High amounts of albumin are filtered in the proximal tubules, and the mechanism is thought to involve two receptors, which can process 250 g of albumin per day. Obviously, any dsyfunction in this protein retrieval pathway wouldl result in nephrotic syndrome.


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