The pathophysiology of systemic edema

The review considers the universal mechanisms of systemic edema and the features of its formation in patients with nephritic and nephrotic syndromes, congestive heart failure, and decompensated cirrhosis. Normally, renal excretion of sodium regulates extracellular fluid volume. Regulation of sodium excretion is achieved by intrinsic mechanisms, which affect glomerular filtration and tubular reabsorption. The pathophysiology of sodium retention has been intensively discussed for several decades. However, underfill and overfill theories are not able to explain the onset of edema. Strong evidence is presented for the role of the endothelial glycocalyx as a determinant of the transcapillary fluid movement. The results of experimental studies demonstrated an increase in sodium reabsorption in cortical tubes in nephrotic and nephritic syndromes due to activation of Na/K ATPase and epithelial sodium channels. But the factor that directly stimulates the sodium channels and transporters remains unidentified. One of the reasons for the sodium retention is a decrease of effective blood volume, which occurs in congestive heart failure and decompensated cirrhosis. Understanding the pathophysiology of systemic edema is important for the choice of the optimal therapy and for the prevention of edema.

почки, отеки, задержка натрия, эффективный артериальный объем крови, нефротический синдром, нефритический синдром, сердечная недостаточность, цирроз, kidneys, edema, sodium retention, effective arterial blood volume, nephrotic syndrome, nephritic syndrome, heart failure, cirrhosis

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