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内科学教学课件:Nephrotic Syndrome

Reduced catabolism of these compounds.
4. Complications
(1) Infection
Malnutrition Disturbance of immune function(WBC function, complememt loss) Therapy of corticosteroid
(3) Acute renal failure
Reduced renal perfusion Severe edema of renal interstitium Drug (harmful to kidney) therapy: Acute bilateral thrombosis of renal vein Could be idiopathic
lymphoma, other cancers.
Drugs--- NSAIDs(non-steroidal antiinflammatory drugs) Hereditary disorder---Alport's syndrome Allergens---bee sting, snake bite, pollen Infections---SBE, HBV, HIV infection
Nephrotic Syndrome (P633)
a group of signs and symptoms, not a single disease (base on extent of proteinuria, not on etiology) 1. Features Large amount of proteinuria, > 3.5g/d Hypoalbuminemia: serum albumin < 30g/L Hyperlipidemia Edema -- Massive proteinuria and hypoalbuminemia are
necessary for diagnosis.
2. Causes
(1) Primary glomerular diseases
Pathological classifications of NS: Minimal change disease (MCD) Membranous nephropathy (MN) Mesangial proliferative GN (MsPGN) Mesangial capillary GN
(4) Severe metabolic disturbance
Classifications and common causes for nephrotic syndrome
Children
youth
aged peoplePr Nhomakorabeamary MCD
MsPGN MPGN FSGS
MN
MCD
Secondary Henoch-Schonlein purpura HBV-associated Congenital
Lupus nephritis Henoch-Schonlein purpura HBV-associated
Diabetic nephropathy Amyloidosis multiple myeloma
3. Pathophysiology (1) Proteinuria
Electrical charge barrier disturbance: MCD, selective proteinuria Size barrier disturbance: non-selective proteinuria
(2) Hypoalbuminemia
Secondary to protein loss in urine. Liver could not produce enough albumin to supplement.
Increased albumin catabolism
Loss of other proteins: IgG, metal-binding proteins, coagulation
component, complement → Hypercoagulable state, iron, copper, zinc deficiency, infection.
(3) Edema
Proteinuria→hypoalbuminemia→plasma oncotic pressure↓→edema
Increased salt and water retention: from RAS↑
(4) Hyperlipidemia:
Increased hepatic synthesis of cholesterol, triglycerides and lipoproteins in the process of albumin synthesis.
Sites: Pathogens:
(2) Thromboembolic events
Reduced effective blood volume Hyperlipidemia Altered clotting factors level
Thrombosis → embolus → embolism Could be life-threatening.
(membrane proliferative GN, MPGN) Focal segmental glomerular sclerosis (FSGS)
(2) Systemic diseases and other disorders: Metabolic disease---Diabetes Mellitus, amyloidosis Autoimmune disease---SLE, Henoch-Schonlein purpura Malignancy---Hodgkin' disease, multiple myeloma,
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