What is the role of nephrotic syndrome in the pathophysiology of azotemia?

Updated: Apr 24, 2020
  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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In nephrotic syndrome, the urinary sediment is inactive, and there is gross proteinuria (> 3.5 g/day), hypoalbuminemia, hyperlipidemia, and edema. Azotemia and hypertension are uncommon initially, but their presence may indicate advanced disease. 

Some patients with nephrotic syndrome may present with AKI. Impairment of capillary circulation in the kidney due to edema (nephrosarca) and tubular obstruction from protein casts, as well as decreased effective circulating volume, have been proposed as potential mechanisms for the development of AKI in patients with nephrotic syndrome.

In nephritic syndrome the urinary sediment is active, with WBC or RBC casts, and granular casts, and azotemia is present. Proteinuria is less obvious, but increased salt and water retention in glomerulonephritis can lead to hypertension, edema formation, decreased output, low urinary excretion of sodium, and increased specific gravity.

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