Pathogenesis (development of disease)
Possible causes of edema are varied. Increased hydrostatic pressure (pressure in the vascular system), decreased oncotic pressure (hypoproteinemia, i.e., decrease in blood protein), increased capillary permeability (vascular permeability), or disturbances in lymphatic drainage can cause edema formation.
Etiology (Causes)
Biographic factors
- Gravidity (pregnancy)
Behavioral risk factors
Causes related to disease
Increased hydrostatic pressure
- Cushing’s syndrome – increased concentration of cortisol in plasma.
- Heart failure (cardiac insufficiency)
- Hyperaldosteronism – excessive aldosterone release from the adrenal cortex.
- Hyperthyroidism (hyperthyroidism).
- Hypothyroidism (hypothyroidism)
- Idiopathic edema – probably after long therapy with diuretics (draining drugs).
- Thrombosis – complete or partial vascular occlusion by a blood clot.
- Corticosteroid therapy
Reduced oncotic pressure
- Exudative enteropathy (protein wasting syndrome).
- Liver parenchymal damage
- Nephrotic syndrome – collective term for symptoms that occur in various diseases of the glomerulus (renal corpuscles); symptoms include: Proteinuria (increased excretion of protein in the urine) with a protein loss of more than 1 g/m²/body surface per day; Hypoproteinemia, peripheral edema due to hypalbuminemia of < 2.5 g/dl in serum, hyperlipoproteinemia (lipid metabolism disorder).
Capillary wall damage – damage to the small vessels.
- Allergies
- Glomerulonephritis – kidney disease, with inflammation of the kidney filterlets (glomeruli).
Disorders of lymphatic drainage in
- Inflammation – for example, erysipelas (acute areal skin infection caused by streptococci ) or arthritis (inflammation of the joints).
- Filariasis – infection with filariae, a type of nematode.
- Lymphatic aplasia – failure to develop – or hypoplasia (underdevelopment) of lymphatic vessels.
- After radiatio (radiotherapy)
- After surgical interventions
- Tumors
Drugs
- ACE inhibitors (angioneurotic edema; incidence(frequency of new cases): approximately 1%; mortality (death rate): 1%) – benazepril, captopril, cilazapril, enalapril, fosinopril, lisinopril, moexipril, peridopril, quinapril, ramipril, spirapril
- Alpha-1 receptor blockers (prazosin).
- Analgesics
- Antirheumatic drugs (NSAIDs), nonsteroidal (acetylsalicylic acid (ASA), diclofenac, indometacin, ibuprofen, meloxicam, piroxicam).
- Selective COX-2 inhibitors (coxibe) – celecoxib, etoricoxib.
- Betamimetics (synonyms: β2-sympathomimetics, also β2-adrenoceptor agonists) – fenoterol, formoterol, hexoprenaline, indaceterol, olodaterol, ritodrine, salbutamol, salmeterol, terbutaline.
- Calcium antagonists (primarily dihydropyridine-type/nifedipine-type agents; second- and third-generation agents such as lercanidipine are better tolerated)
- Diuretics – especially loop diuretics such as furosemide and torasemide, which can cause leg edema
- Endothelin receptor antagonists (endothelin receptor antagonists) – bosentan.
- Hormones
- Androgens (testosterone, testosterone antate, testosterone undecaonate).
- Progestogens (etonogestrel, desogestrel, dienogest, levonorgestrel, medroxyprogesterone acetate, medrogestone, norelgestromin, norethisterone).
- Glucocorticoids (cortisone, dexamethasone, prednisolone, prednisone).
- Contraceptives (estrogen-progestin combination).
- Estrogens (ethinyl estradiol, estradiol).
- Growth hormone (somatotropic hormone (STH), human growth hormone (hGH), growth hormone (GH), growth hormone (WH), somatropin (INN)).
- Immunosuppressants (thalidomide).
- Interleukin-2 (IL-2), also known as T-cell growth factor (TCGF).
- Monoclonal antibodies – pertuzumab, trastuzumab.
- Psychotropic drugs – atypical neuroleptics, lithium, MAO inhibitors, tricyclic antidepressants.
- Thionamides (carbimazole, propylthiouracil, thiamazole).
- Vasodilators (dihydralazine, minoxidil).
Operations
- Especially after major surgery with removal of larger portions of tissue, the drainage of lymphatic fluid can be impeded