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Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome
Generalized edema is a major presenting clinical feature of children with nephrotic syndrome (NS) exemplified by such primary conditions as minimal change disease (MCD). In these children with classical NS and marked proteinuria and hypoalbuminemia, the ensuing tendency to hypovolemia triggers compe...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2016
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707228/ https://www.ncbi.nlm.nih.gov/pubmed/26793696 http://dx.doi.org/10.3389/fped.2015.00111 |
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author | Ellis, Demetrius |
author_facet | Ellis, Demetrius |
author_sort | Ellis, Demetrius |
collection | PubMed |
description | Generalized edema is a major presenting clinical feature of children with nephrotic syndrome (NS) exemplified by such primary conditions as minimal change disease (MCD). In these children with classical NS and marked proteinuria and hypoalbuminemia, the ensuing tendency to hypovolemia triggers compensatory physiological mechanisms, which enhance renal sodium (Na(+)) and water retention; this is known as the “underfill hypothesis.” Edema can also occur in secondary forms of NS and several other glomerulonephritides, in which the degree of proteinuria and hypoalbuminemia, are variable. In contrast to MCD, in these latter conditions, the predominant mechanism of edema formation is “primary” or “pathophysiological,” Na(+) and water retention; this is known as the “overfill hypothesis.” A major clinical challenge in children with these disorders is to distinguish the predominant mechanism of edema formation, identify other potential contributing factors, and prevent the deleterious effects of diuretic regimens in those with unsuspected reduced effective circulatory volume (i.e., underfill). This article reviews the Starling forces that become altered in NS so as to tip the balance of fluid movement in favor of edema formation. An understanding of these pathomechanisms then serves to formulate a more rational approach to prevention, evaluation, and management of such edema. |
format | Online Article Text |
id | pubmed-4707228 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-47072282016-01-20 Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome Ellis, Demetrius Front Pediatr Pediatrics Generalized edema is a major presenting clinical feature of children with nephrotic syndrome (NS) exemplified by such primary conditions as minimal change disease (MCD). In these children with classical NS and marked proteinuria and hypoalbuminemia, the ensuing tendency to hypovolemia triggers compensatory physiological mechanisms, which enhance renal sodium (Na(+)) and water retention; this is known as the “underfill hypothesis.” Edema can also occur in secondary forms of NS and several other glomerulonephritides, in which the degree of proteinuria and hypoalbuminemia, are variable. In contrast to MCD, in these latter conditions, the predominant mechanism of edema formation is “primary” or “pathophysiological,” Na(+) and water retention; this is known as the “overfill hypothesis.” A major clinical challenge in children with these disorders is to distinguish the predominant mechanism of edema formation, identify other potential contributing factors, and prevent the deleterious effects of diuretic regimens in those with unsuspected reduced effective circulatory volume (i.e., underfill). This article reviews the Starling forces that become altered in NS so as to tip the balance of fluid movement in favor of edema formation. An understanding of these pathomechanisms then serves to formulate a more rational approach to prevention, evaluation, and management of such edema. Frontiers Media S.A. 2016-01-11 /pmc/articles/PMC4707228/ /pubmed/26793696 http://dx.doi.org/10.3389/fped.2015.00111 Text en Copyright © 2016 Ellis. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pediatrics Ellis, Demetrius Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome |
title | Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome |
title_full | Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome |
title_fullStr | Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome |
title_full_unstemmed | Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome |
title_short | Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome |
title_sort | pathophysiology, evaluation, and management of edema in childhood nephrotic syndrome |
topic | Pediatrics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707228/ https://www.ncbi.nlm.nih.gov/pubmed/26793696 http://dx.doi.org/10.3389/fped.2015.00111 |
work_keys_str_mv | AT ellisdemetrius pathophysiologyevaluationandmanagementofedemainchildhoodnephroticsyndrome |