Pathophysiology and etiology of edema in children
- Rudolph P Valentini, MD
Rudolph P Valentini, MD
- Professor of Pediatrics
- Wayne State University School of Medicine
Edema is a clinical condition characterized by an increase in interstitial fluid volume and tissue swelling that can either be localized or generalized. Severe generalized edema is known as anasarca. More localized interstitial fluid collections include ascites and pleural effusions.
The diagnostic approach to edema is based upon a thoughtful approach to the pathogenesis of its formation. Once a diagnosis is established, specific treatment of the underlying disorder can be given. If specific therapy is not available, general treatment, such as optimization of fluid management, can be provided.
The pediatric disease processes associated with edema and the pathogenesis of edema will be described in this topic review. More detailed discussions of evaluation and management of edema in children as well as the pathophysiology of edema are presented separately. (See "Evaluation and management of edema in children".)
OVERVIEW OF PATHOPHYSIOLOGY
Normal physiology — Edema does not occur in normal subjects because of the tight balance of hemodynamic forces along the capillary wall and the intact function of the lymphatic system. While capillary hydrostatic pressure favors transcapillary fluid movement into the interstitium, the colloid oncotic pressure across the capillary favors the retention of fluid within the vessel (figure 1). Under normal circumstances, these competing forces result in a small net movement of fluid into the interstitium. The lymphatic vessels return this interstitial fluid to the venous system thereby preventing edema formation.
Pathophysiology of edema — The following physiologic processes result in edema formation:
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- OVERVIEW OF PATHOPHYSIOLOGY
- Normal physiology
- Pathophysiology of edema
- - Altered capillary hemodynamics
- - Impaired lymphatic transport
- - Renal salt and water retention
- Increased hydrostatic pressure from sodium and water retention
- - Heart failure
- - Acute glomerulonephritis
- - Renal failure
- - Drugs
- Increased capillary hydrostatic pressure from obstruction
- - Venous obstruction
- - Cirrhosis
- Decreased capillary oncotic pressure
- - Protein malnutrition
- - Protein losing enteropathy
- Increased capillary permeability
- - Angioedema
- Nephrotic syndrome
- Lymphatic dysfunction/obstruction
- - Primary lymphedema
- Lymphedema precox
- Congenital lymphedema
- Lymphedema tarda
- - Secondary lymphedema