腎病綜合征（英文版）

NephroticSyndromeDefinitionGlomerularpermeability↑Clinicalfeatures

MassiveproteinuriaHypoproteinemia

HyperlipidemiaEdemaEpidemiologyMale:female=3.7:1PreschoolClassificationPrimary/Idiopathic(90%)SecondarySLEHBVAnaphylactoidpurpuraCongenitalPathogenesisGlomerularpermeabilityProteinuriaHypoproteinemiaEdema

HyperlipidemiaApertureBarrierEndotheliumslitdiaphragmCharge-SelectiveBarrierEndotheliumEtiology腎小球毛細血管壁結(jié)構(gòu)或電荷的變化可導致蛋白尿。高選擇性蛋白尿低選擇性蛋白尿病因及發(fā)病機制目前尚不明確局部免疫病理過程可損傷濾過膜正常屏障作用T淋巴細胞異常具有遺傳基礎PathophysiologyHypoproteinemiaHyperlipidemiaEdemaOthersMinimalchangedisease(MCD)(76.4%)Mesangialproliferativeglomerulonephritis(MsPGN)Focalsegmentalglomerulosclerosis(FSGS)Membranousnephrosis(MN)Membranoproliferativeglomerulonephritis(MPGN)PathologicalChangesDamageofGBMGenaralsituationEdema、Ascites、PleuraleffusionHematuriaBloodpressureRenalfunctionClinicalManifestationEdema、ascitesComplications

InfectionElectrolytedisorderandhypovolemiaHypercoagulabilityandthrombosisAcuterenalfailureRenaltubularfunctiondisorderInfectionManifestationsURISpontaneousperitonitis（自發(fā)性腹膜炎）TuberculosisCellulitis（蜂窩織炎）UrinarytractinfectionInfectionCausesImmunoglobulinandcomplementfactor↓ProteinmalnutritionEdemaImmunosuppressivetherapyManagementandProphylaxisHeightenourvigilancePromptevaluationEarlytherapyManifestationsHyponatremiaHypokalemiaHypocalcemiaHypovolemicshockElectrolytesDisorderandHypovolemiaCausesSaltintakerestrictionDiuretictreatmentVomit,Diarrhea,intestinalreabsorbtionLossofbindingproteinProphylaxisAvoidingaggressivediuretictherapyAppropriatesaltintakeElectrolytesDisorderandHypovolemiaHypercoagulabilityandThrombosisManifestationsBrainSkinLungKidneyScrotum（陰囊）

ExtremitiesHypercoagulabilityandThrombosisCausesCoagulationfactors↑Plateletaggregation↑AntithrombinⅢ↓HyperlipidemiaDiuretictherapySteroidtherapyHypercoagulabilityandThrombosisProphylaxisAvoidingpunctureofdeepveinsProphylacticanticoagulationdrugsManifestationsOliguriaoranuriaHypertensionElevatedserumCrandBUNlevelsAcuteRenalFailureCausesBloodvolume↓CrescentformationAcuteinterstitialnephritisDrugsProphylaxisAvoidinguseofrenaltoxicdrugsAvoidingaggressivediuretictherapyAcuteRenalFailureRenalTubularFunctionDisorderManifestationsRenalglycosuriaAminoaciduriaFanconisyndromUrineUrinalysis,24hurinaryprotein,UrinaryPro/CrSerumAlbumin,cholesterol,triglycerideIgG,IgA,IgMSodium,potassium,calciumCoagulationfunctionBUN,CrLaboratoryTestsC3ASO乙肝兩對半系統(tǒng)性疾病的血清學檢查UltrasonographyRenalbiopsyLaboratoryTestsDiagnosis24hurinaryprotein＞50mg/(kg.d)Serumalbumin＜30g/LSerumcholesterol＞5.7mmol/LEdemaSimpletypeNephritictype

Classification

NephritictypeHematuriaHypertensionRenalfunctioninsufficientHypocomplementemiaClassificationDifferentialDiagnosisIsedemacausedbyrenaldiseases？Nephroticsyndrome？Simpletypeornephritictype？Primary,secondaryorcongenital？TreatmentGeneraltreatmentRestDiet:sodium,protein,calciumandvitaminDPreventandcureinfectionDiuresisEducationTreatmentSteroidPrednisonePrednisoloneImmunosupressivedrugsCTXCsAMMFFK506TreatmentAnticoagulanttherapyOthersACEIImmunologicregulatorsChinesemedicineTreatmentSideeffectsofcorticosteroidMetabolicdisturbanceHypertensionInfectionPepticulcerEuphoria,iunacy,induceepilepsy,insomniaOsteoporosis,growthretardationCataract(白內(nèi)障)AdrenalinsufficiencyTreatmentIndicationsforcytotoxicdrugsFrequentrelapseSteroiddependentSteroidresistantUnabletotoleratesteroidtreatmentSideeffectsofCT