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Mechanism and treatment of edema in nephrotic syndrome

UNDERFILLING VERSUS RENAL SODIUM RETENTION

Edema is one of the major clinical manifestations of the nephrotic syndrome. Two major factors have been thought to be responsible for this problem and it is likely that both contribute to a variable degree in individual patients [1,2]:

  • Arterial underfilling as the low plasma oncotic pressure leads to plasma volume depletion
  • Sodium retention directly induced by the renal disease

The clinical importance of distinguishing between these mechanisms is that nephrotic patients are often markedly edematous. Although diuretic therapy will relieve the edema, it would lead to worsening hypovolemia if underfilling were the primary mechanism. As will be described below, most patients tolerate diuretic therapy.

Starling's law — The presumed primary importance of arterial underfilling seems to be predicted from Starling's law, which states that the exchange of fluid between the plasma and the interstitium is determined by the hydraulic and oncotic pressures in each compartment:

 Net filtration across the capillary wall

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Last literature review version 18.2: May 2010
This topic last updated: June 8, 2010
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