Nephrotic syndrome mechanisms

Membranous- type picture, with. nephrotic syndrome. (mechanism unknown) . ... 

Membranous-type picture with nephro.tic syndrome (mechanism unlcnown) . . Membranous-type picture.with nephrotic syndrome (mechanism miknown)... 

Clofibrate causes a necrotizing myopathy, particularly in patients with renal failure, nephrotic syndrome or hypothyroidism. The myopathy is painful and myokymia of unknown origin is sometimes present. The mechanism of damage is not known, but p-chlorophenol is a major metabolite of clofibrate and p-chlorophe-nol is a particularly potent uncoupler of cellular oxidative phosphorylation and disrupts the fluidity of lipid membranes. Muscle damage is repaired rapidly on the cessation of treatment. 

Prednisolone can cause an abrupt rise in proteinuria in patients with nephrotic syndrome. A placebo-controlled study in 26 patients aged 18-68 years with nephrotic syndrome has clarified the mechanisms responsible for this (163). Systemic and renal hemodynamics and urinary protein excretion were measured after prednisolone (125 mg or 150 mg when body weight exceeded 75 kg) and after placebo. Prednisolone increased proteinuria by changing the size-selective barrier of the glomerular capillaries. Neither the renin-angiotensin axis nor prostaglandins were involved in these effects of prednisolone on proteinuria. 

Aleo MD, Navetta KA, Emeigh Hart SG et al. (2002) Mechanism-based urinary biomarkers of aminoglycoside-induced phospholipidosis. Comp Clin Pathol 11 193-194 de Mendoza SG, Kashyap ML, Chen CY, Lutmer RF (1976) High density lipoproteinuria in nephrotic syndrome. Metabolism 25 1143-1149... 

A 73-year-old man who had taken pergolide 1.5 mg/day for 4 months developed dyspnea, bilateral pleural effusions, and severe edema of the legs up to the scrotum (5). There was no pleural thickening or any evidence of cardiac failure or nephrotic syndrome. These chnical features were resistant to diuretic therapy but resolved completely within a month of withdrawal of pergohde. The mechanism of this type of very rare reaction is totally unknown. 

Bisphoshonates are used for treatment of hypercalcemia, fracture prevention and in patients with metastatic cancer. This class of drugs reduce morbidity from hypercalcemia is increasingly recognized to cause nephrotoxicity [14]. Both pamidronate and zoledronate have been associated with nephrotoxicity that features nephrotic syndrome with a collapsing glomerular sclerosis [47]. The mechanism is unkown and the return of renal function is slow. 

KIrchner KA,Voelker JR, Brater DC. Intratubular albumin blunts the response to furosemide-a mechanism for diuretic resistance in the nephrotic syndrome. Pharmacol Exp Ther 1990 252 1097-101. 

Doublier S, Ruotsalainen V, SalvidioG, Lupia E, Biancone L,Conaldi PG, Reponen P,Tryggvason K,Camussi G Nephrin redistribution on podocytes is a potential mechanism for proteinuria in patients with primary acquired nephrotic syndrome. Am J Pathol 2001 158 1723-31. 

Deschenes G, Feraille E, Doucet A. Mechanisms of oedema in nephrotic syndrome Old theories and new ideas. Nephrol Dial Transplant 2003 18 454-6. 

The role of both T and B lymphocytes in a variety of disease states beyond transplantation has become increasingly important in the past decade. This is especially true of those diseases frequently referred to as autoimmune in their etiology, such as rheumatoid arthritis, nephrotic syndrome, systemic lupus erythematosus, inflammatory bowel disease, and so on. In addition, several other major diseases are also known to have a component of T- or B-cell-mediated pathogenesis, for example, atopic dermatitis, psoriasis, and asthma. Until very recently, the mainstay of therapy for these diseases was the corticosteroids, which were often less than satisfactory in efficacy and often associated with undesirable side effects, especially in growing children and the elderly. Thus, the search for new agents with different mechanisms of action and which did not have the same adverse event profile as conventional corticosteroids led to the subsequent evaluation of drugs such as tacrolimus and sirolimus to treat several of these diseases. 

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