The glomerular filtration barrier is formed by

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THE GLOMERULAR FILTRATION BARRIER IS FORMED BY GLOMERULAR BASEMENT MEMBRANE, PODOCYTES AND SLIT DIAPHRAGM. THE LARGEST PROPORTION OF PROTEIN LOST IN THE URINE IS ALBUMIN. SOMETIMES, GLOBULINS CAN ALSO BE EXCRETED (IMMUNOGLOBULIN EXCRETION LEADS TO INCREASED INFECTION). 98
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OTHER PROTEINS WHICH ARE ALSO EXCRETED IN SIGNIFICANT AMOUNTS:- - TRANSFERRIN - CHOLECALCIFEROL BINDING PROTEIN - THYROXINE BINDING GLOBULIN - CERULOPLASMIN - ANTITHROMBIN III 99
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PATHOPHYSIOLOGICAL BASIS OF ABNORMALITIES SEEN IN NEPHROTIC SYNDROME 100
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101
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NEPHROTIC SYNDROME ALL ARE TRUE OF NEPHROTIC SYNDROME, EXCEPT (AI 2K) A) RBC CASTS IN URINE B) HYPO-PROTEINEMIA C) OEDEMA D) HYPERLIPIDEMIA ANS. IS ‘A’ I.E., RBC CAST IN URINE [REF: CMDT2003 P. 891 & 2001 P. 916; HARRISON 18,H/EP] RBC CAST IN URINE IS A FEATURE OF NEPHRITIC SYNDROME, NOT NEPHROTIC SYNDROME. 103
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ALL OF THE FOLLOWING ARE DECREASE IN NEPHROTIC SYNDROME EXCEPT - (AI 97) A) TRANSFERRIN B) CERULOPLASMIN C) FIBRINOGEN D) ALBUMIN ANS. IS ‘C’ I.E., FIBRINOGEN [REF: HARRISON 18,H/EP. 2345; 1790, 1789] 104
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WHICH IS SEEN IN NEPHROTIC SYNDROME- (PGI JUNE 99) A) LOW SERUM CALCIUM B) RAISED AT-III C) LOW LIPID D) PLATELET ACTIVATION ANS. IS ‘A’ I.E., LOW SERUM CALCIUM; ‘D’ I.E., PLATELET ACTIVATION [REF: HARRISON 18,H/EP. 2345] 105
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LIPID PROFILE IN NEPHROTIC SYNDROME IS – INCREASED CHOLESTEROL . INCREASED TRIGLYCERIDES . INCREASED VLDL . INCREASED LDL 106
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IN NEPHROTIC SYNDROME HYPERCOAGUABILITY OCCURS DUE TO- (PGINOV 09) A) DECR. ANTITHROMBIN III B) DECR. PROTEIN C C) INCR. FACTOR S D) INCR. FACTOR VIII E) DECR. PLASMINOGEN 107
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COAGULATION FACTORS IN NEPHROTIC SYNDROME:- INCREASED PLATELET AGGREGATION AND ACTIVATION. ELEVATION IN FACTOR V, VII, VIII, XIII AND FIBRINOGEN. DECREASED ANTI-THROMBIN III (DUE TO INCREASED URINARY EXCRETION). DECREASED PROTEIN C AND S. • DECREASED FIBRINOLYSIS - INCREASED FIBRINOGEN - INCREASED A2 ANTIPLASMIN - DECREASED PLASMINOGEN - FACTOR 12. (REDUCED SYNTHESIS, INCREASED CATABOLISM, UNUSUAL LOSSES) 108
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IN NEPHROTIC SYNDROME HYPERCOAGUABILITY OCCURS DUE TO- (PGINOV 09) A) DECR. ANTITHROMBIN III B) DECR. PROTEIN C C) INCR. FACTOR S D) INCR. FACTOR VIII E) DECR. PLASMINOGEN ANS. IS ‘A’ ‘B’ ‘D’ ‘E’ 109
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ALL OF THE FOLLOWING ARE DECREASE IN NEPHROTIC SYNDROME EXCEPT - (AI 9 7) A) TRANSFERRIN B) CERULOPLASMIN C) FIBRINOGEN D) ALBUMIN ANS. IS ‘C’ I.E., FIBRINOGEN [REF: HARRISON I8,H/EP. 2345, 338, 339; 17H/EP. 1790, 59] 110
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MOST COMMON CAUSE OF NEPHROTIC RANGE PROTEINURIA IN AN ADULT IS- (AI 07) A) DIABETES MELLITUS B) AMYLOIDOSIS C) HYPERTENSIVE NEPHROPATHY D) WEGNER'S GRANULOMATOSIS ANS. IS ‘A’ I.E., DIABETES MELLITUS DIABETES MELLITUS IS THE MOST COMMON CAUSE OF NEPHROTIC RANGE PROTEINURIA IN ADULTS.
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