Nephrotic Syndrome

There is a large body of clinical evidence against the theory that the hypoalbuminaemia is the driving force for oedema formation.

• Analbuminaemic patients have only minimal or no oedema, despite low plasma oncotic pressure.
• In children with steroid-sensitive nephrotic syndrome, natriuresis starts at the same time as proteinuria ceases, before the serum albumin has risen.
• Blood volume does not correlate with plasma oncotic pressure in nephrotic patients.
• When children relapse, 21% display hypertension, but only 4% exhibit circulatory collapse. Only 1% display hypovolaemia, whereas 17% manifest hypervolaemia.
• Intravenous administration of albumin leads to volume expansion but only minimal natriuresis.
• Blockade of mineralo-corticoid receptors or inhibition of angiotensin-converting enzyme has no effect on natriuresis in most patients.

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