[New views on the pathophysiology of the nephrotic syndrome]

The authors draw attention to new pathophysiological aspects of some symptoms of the nephrotic syndrome (NS), in particular proteinuria, hypoalbuminaemia and oedema. In proteinuria they focus attention on the formation of a new population of heteropores in severe morphological forms of NS with penetration of high molecular proteins into urine. In hypoalbuminaemia the authors emphasize the importance of an inadequately increased albumin synthesis in the liver. In case of oedema in the majority of patients hypovolaemia is not present, as was assumed so far. In the pathogenesis of oedema primary Na retention in the kidneys is important caused by the glomerulonephritic process. New findings in the pathophysiology of NS lead to changes of several clinical approaches. The authors draw attention e.g. to the need of dietary protein restriction in NS, on altered effects of drugs in NS, new approaches to diuretic treatment etc.