肾病综合征英文 课件

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1、NephroticSyndromeTheoutlinesDefinitionofNephroticsyndromeEtiologyPathogenesisClinicalpictureDiagnosticworkupPathologicalpictureComplicationManagementsWhatisNephroticsyndrome?proteinuria(>3.5g/day),hypoalbuminemia(<30g/L)edemahyperlipidemiaTypesofnephroticsyndrome(1

2、)Idiopathicnephroticsyndrome:Etiologyofthediseaseisunknown,accountingforapproximately90%ofnephrosisinchildhood.(2)Secondarynephrosis:NSresultedfromsystemicdiseasesuchasanaphylactoidpurpura,systemiclupusErythematosus(SLE),andsoon.EtiologyEtiologyEtiologyEtiologyEtio

3、logyInchildrenMinimalchangediseaseispredominantInadultsSystemicdiseaserelated:30%Primaryrenaldisorders:70%MembranousnephropathyFocalglomerulosclerosisMinimalchangediseaseAmyloidosisInelderlyIncreasedincidenceofamyloidosisanddecreasedincidenceofSLEPathogenesisDAMAGE

4、DProteinuria(1)Proteinuria:Massiveproteinuriaisthemostchiefcharacteristicsofnephrosisresultingfromanincreaseinglomerularcapillarywallpermeabilitytoplasmaprotein.Themechanismmayberelatedto①Molecularbarrierinjury:holesonGBMbecomelarger;②Chargebarrierinjury:lossofnega

5、tive(2)Hypoproteinemia①Plasmaproteinislostbyurine;②Proteincatabolism↑,sototalplasmaproteinconcentration↓,especiallyalbumin.(3)HyperlipidemiaAllserumlipid(cholesterol,triglycerides)andlipoproteinlevelsareelevated.A.Hypoproteinemiastimulatesgeneralizedproteinsynthesi

6、sintheliver,includingthelipoprotein;B.Lipidcatabolismisdiminished.(4)EdemaA.Hypoalbuminemialeadstoadecreaseinplasmaosmoticpressure,whichpermitsthetranslationoffluidfromintravascularcompartmenttointerstitialspace.B.Theintravascularvolume↓makerenalperfusionpressure↓a

7、ctivatingrennin-angiotensin-aldosteronesystem,whichstimulatesdistaltubularreabsorptionofsodium↑.C.Reducedintravascularvolumealsostimulatesthereleaseofantidiuretichormone,whichenhancesthereabsorptionofwaterinthecollectingduct.D.Becauseofplasmaosmoticpressure↓,thesod

8、iumandwaterenterinterstitialspacePathologyInadults,thenephroticsyndromeisacommonconditionleadingtorenalbiopsy.Inmanystudies,patientswithheavyprot