Felis ISSN 2398-2950

Nephrotic syndrome

Contributor(s): Samantha Taylor

Introduction

  • Syndrome of severe proteinuria, hypoproteinemia, hypercholesterolemia and edema or ascites.
  • Cause: glomerulonephritis or amyloidosis.
  • Signs: edema (central or peripheral).
  • Diagnosis: signs, laboratory data.
  • Treatment: dietary manipulation and symptomatic removal of fluid.
  • Prognosis: guarded.

Pathogenesis

Etiology

Predisposing factors

General

  • Breed.
  • Inflammatory/infectious process.

Pathophysiology

  • Immune complexes or amyloid are deposited on glomerular basement membrane   →   loss of normal glomerular basement membrane   →   proteinuria   →   loss of intravascular oncotic pressure   →   edema and hypercholesterolemia (in response to decreased oncotic pressure).
  • Chronic renal protein loss   →   inflammatory cells and mediators in glomerulus   →   kidney disease.
  • Chronic renal loss of antithrombin III, increased synthesis of fibrinogen and increased platelet adhesiveness   →   hypercoagulable state.
  • Proteinuria Proteinuria  →   reduced oncotic pressure   →    transudation of fluid into interstitial space   →    hypovolemia (and edema)    →   activates renin-angiotensin-aldosterone system, may   →   hypertension/aggravation of fluid retention.
  • Nephrotic syndrome defined by presence of proteinuria, hypoalbuminemia, hypercholesterolemia and excessive fluid accumulation Ascites 01: whole cat  Ascites 02: whole cat  Ascites 03: whole cat .

Timecourse

  • A few recover or the disease may be controlled for months-years.
  • Rapid progression if kidney disease.
  • Acute presentation and rapid deterioration with thrombus formation.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Littman M P (2011) Protein-losing nephropathy in small animals. Vet Clin North Am Small Anim Pract 41 (1), 31-62 PubMed.
  • Syme H (2011) Hypertension in small animal kidney disease. Vet Clin North Am Small Anim Pract 41 (1), 63-89 PubMed.


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