PATHOPHYSIOLOGY

A metabolic, biochemical, or physiochemical disturbances in the basement membrane of

the glomeruli may lead to increased permeability to protein, but the cause and mechanisms are
only speculative.

The glomerular membrane, which is normally impermeable to albumin and other large proteins,
becomes permeable to proteins, especially albumin, which leak through the membrane and are
lost in urine (hyperalbuminemia). This reduces the serum albumin level(hypoalbuminemia),
which decreases the COP in the capillaries. As a result, the hydrostatic pressure exceeds the pull
of the COP, and fluid accumulates in the interstitial spaces and body cavities, particularly the
abdominal cavity (ascites). The shift of the fluid from the plasma to the interstitial spaces reduces
the vascular fluid ( hypovolemia ) which inturn stimulates the renin angiotensin systemand the
secretion of antidiuretic hormone and aldosterone. Tubular reabsorption of sodium and water
increased in an attempt to increase intravascular volume. The elevation of serum cholesterol,
phospholipids , and triglycerides is unexplained
 Predisposing factors: Precipitating factors:
Age
Gender Medical condition
Genetic Medication
Unknown Infection
Direct glomerular
damage

Inflammation

Damage to the glomerular

membrane Lodging of antigen-antibody
complexes in the glomerular
membrane
Fibrosis, scarring, sclerosis
of the glomerulus
Release of inflammatory Pain and
mediators
tenderness
on the back
Decrease in glomerular
Hyperpermeability of the Renal failure
filtration rate
glomerular membrane

Fatigue, difficulty of
Sodium and water breathing, anemia,
Increased urinary retention nausea and vomiting
frequency, proteinuria,
albuminuria, hematuria
Diuretics
Decreased urinary output,
Edema, Hypertension

Dark frothy urine Angiotensin Converting

Enzyme Inhibitors,
Amgiotensin II receprotr
Congestive heart failure, blockers for hypertension
Pulmonary edema

LEGEND:

Causes
Diet modifications: low
salt, low fat, low protein Disease process
diet. Fluid restrictions as
Reaction/compensation
advised
Signs and symptoms

Complications

Treatment and management