Journal
PEDIATRIC NEPHROLOGY
Volume 22, Issue 12, Pages 1983-1990Publisher
SPRINGER
DOI: 10.1007/s00467-007-0521-3
Keywords
sodium retention; collecting duct; Na,K-ATPase; epithelial sodium channels (ENaCs); aldosterone; capillary hydraulic conductivity; diuretics
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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.
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