Serum albumin levels are reduced in patients with nephrotic syndrome and gross proteinuria. Are serum Freelite levels also reduced in patients with proteinuria?
No. Renal damage never increases the glomerular filtration rate of small molecules such as FLCs or creatinine since they normally pass relatively unhindered through the glomerular pores. Molecules as large as albumin are not normally filtered by the kidney but they are cleared in nephrotic syndrome as the glomerular pores become damaged. The extra protein leakage overwhelms the proximal tubular reabsorption mechanisms allowing many different proteins to appear in the urine. The protein leakage damages the tubules in the process which become sclerotic. Renal clearance of all small proteins is then reduced. This leads to an increase in sFLC levels (and creatinine). In the early stages of the process, FLCs are increased in the urine because of increased competition with albumin for reabsorption by the proximal tubules. Renal impairment leads to increases in both κ and λ FLCs in the serum. Therefore, when both are elevated the likely cause is a reduction in glomerular filtration. There is
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