Molecular mechanism of edema formation in nephrotic syndrome: therapeutic implications.
Sodium retention and edema are common features of nephrotic syndrome that are classically attributed to hypovolemia and activation of the renin-angiotensin-aldosterone system. However, numbers of clinical and experimental findings argue against this underfill theory. In this review we analyze data from the literature in both nephrotic patients and experimental models of nephrotic syndrome that converge to demonstrate that sodium retention is not related to the renin-angiotensin-aldosterone status and that fluid leakage from capillary to the interstitium does not result from an imbalance of Starling forces, but from changes of the intrinsic properties of the capillary endothelial filtration barrier. We also discuss how most recent findings on the cellular and molecular mechanisms of sodium retention has allowed the development of an efficient treatment of edema in nephrotic patients.
Doucet
Alain
A
Laboratoire de Physiologie et Génomique Rénales, CNRS/UPMC UMR 7134, Institut des Cordeliers, 15 rue de l'Ecole de Médecine, 75270, Paris, France. alain.doucet@bhdc.jussieu.fr
Favre
Guillaume
G
Deschênes
Georges
G
D000818:Animals; D002199:Capillary Permeability / Q000502:physiology; D004195:Disease Models, Animal; D004232:Diuretics / Q000627:therapeutic use; D004487:Edema / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D004730:Endothelium, Vascular / Q000378:metabolism; D053503:Epithelial Sodium Channels / Q000378:metabolism; D006801:Humans; D009404:Nephrotic Syndrome / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D051381:Rats; D012964:Sodium / Q000378:metabolism; D000254:Sodium-Potassium-Exchanging ATPase / Q000378:metabolism
D004232:Diuretics; D053503:Epithelial Sodium Channels; D012964:Sodium; D000254:Sodium-Potassium-Exchanging ATPase