The Nephrotic Syndrome

Abstract

The outstanding clinical feature of the nephrotic syndrome is a generalized persistent type of edema, frequently of severe degree, associated with remarkably little subjective discomfort. Remissions without obvious cause are characteristic of the syndrome. Frequently, the patient is able to carry on his ordinary occupation without distress or discomfort over long periods of time. The patient's appearance often is strikingly suggestive of severe hypothyroidism, and it is interesting to note that both conditions have the common finding of lowered basal metabolic rates and increased blood cholesterol levels.

The nephrotic patient regularly shows a heavy proteinuria, this being due largely to the increased permeability of the glomerular capillaries to albumen, although all fractions of the protein of the blood plasma participate to some degree. Microscopic examination of the urine regularly reveals the presence of large numbers of granular, hyaline, and epithelial casts which are evidence of the severe tubular damage which is pathologically characteristic of the lesions. A few white blood cells commonly are present. In the majority of instances, red blood cells are lacking. Study of the urinary sediment with the polarizing microscope reveals the presence of doubly refractile lipoid bodies which are considered largely pathognomonic of the condition. However, their presence in the urine has been shown in other degenerative lesions of the tubular epithelium.

The most characteristic finding in the laboratory examination is a reduction in total plasma protein which may fall well below the level at which edema occurs. The protein loss is chiefly in the albumen. . .