Orginal Publication Date
MCV/Q, Medical College of Virginia Quarterly
The nephrotic syndrome represents one of the major clinical problems in nephrology. It is usually defined as the constellation of clinical findings which includes edema, massive proteinuria, low serum albumin, high serum cholesterol, and the presence of oval fat bodies in the urine. However, if we focus on the primary disturbance in the patient, that is, massive proteinuria, the nephrotic syndrome may be defined more simply as the clinical and metabolic consequences of persistent and massive proteinuria. The other manifestations listed in the classic definition are all inconstant and secondary to this loss of protein and may be found in other clinical disorders. Proteinuria is considered massive when it is greater than 3.5 mg/kg body weight per day, and persistent when present for many weeks or months. For diagnosis of the nephrotic syndrome, 24-hour urine protein excretion must be measured; a spot measurement is inadequate because some patients with massive proteinuria produce occasional specimens with little or no protein.
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