Syndrome néphrotique

Nephrotic syndrome associates high albuminuria with hypo-albuminemia and abnormalities in lipid metabolism, such as abnormalities related to renal glomerular alterations, either primary or secondary to general diseases such as diabetes, connective tissue diseases and some infections or toxicities. Oedema is the main clinical mark, but nephrotic syndrome can worsen with the development of arterial hypertension, renal failure, infection or thrombosis. The diagnosis is both clinical and biological with the analysis of urine proteins (24 hours proteinuria, electrophoresis of urine proteins, albumin determination, immune-fixations) in mirror of the analysis of serum proteins (electrophoresis, albumin determination, immune-fixations) and moreover with the determination of glomerular filtration rate based on creatinine measures. Primary glomerulonephritis (without evident etiology) must be explored by the anatomic pathology study of the renal biopsy, which can show glomerular alterations more or less serious and extensive with sometimes deposits of immunoglobulin, complement proteins or immune complexes. Nephrotic syndrome in children is generally benign and has a good response to corticotherapy. At the contrary, in adults, renal alterations are more extensive and proliferative worsening the renal prognosis until final renal failure becoming a candidate for renal transplantation. A nephrotic syndrome can be discovered in the course of systematic screenings such as at school or occupational medicine or in pregnant women because this syndrome is frequent near the end of pregnancy. Glomerular alteration can be detected in diabetic patients, also in patients with systemic lupus, purpura nephritis or amyloidosis, as well as in cancer, leukemia, infectious diseases and iatrogenic sources of nephrotic syndrome.