〖医学〗肾脏及泌尿系疾病经常会引起一些临床症状教材-课件.ppt

Figure 7a. Early MN: a glomerulus from a patient with severe nephrotic syndrome and early MN, exhibiting normal architecture and peripheral capillary basement membranes of normal thickness (Silver–methenamine ×400). * Nephrotic syndrome Figure 1. Nephrotic edema. Figure 2. Nephrotic edema. Clinical Syndrome 肾脏及泌尿系疾病经常会引起一些临床症状、 体征和实验室表现相似的综合征。识别患者属于哪一种综合征对诊断很有帮助，因为导致每个综合征的病因较之其包含的个别临床症状和体征的致病原因要少，故识别患者属于哪一种综合征对诊断有帮助。 The most common syndrome of kidney disease Nephrotic syndrome Nephritic syndrome Asymptomatic urinary abnormalities Acute renal failure or Rapidly progressive renal failure Chronic kidney disease(Table 1) (一)肾病综合征 (二)肾炎综合征 (三)无症状性尿检异常 (四)急性及急进性肾衰竭综合征 (五)慢性肾脏病(表1) 肾脏疾病常见综合征 Table 1. STAGES OF CHRONIC KIDNEY DISEASE* STAGE DESCRIPTION GFR (mL/min/1.73m2) 1 Kidney damage with normal or ↑ GFR ≥90 2 Kidney damage with mild or ↓ GFR 60-89 3 Moderate ↓ GFR 30-59 4 Severe ↓ GFR 15-29 5 Kidney failure 15 (or dialysis) * Chronic kidney disease is defined as either kidney damage or GFR 60mL/min/1.73m2 for ≥ 3months. Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests or image studies. Nephrotic syndrome This is characterized by proteinuria (Typically 3.5g/24h), hypoalbuminemia ( less than 30g/dL ) and edema. Hyperlipidaemia is also present. Primary and secondary causes are summarized in Table 2, 3 In practice, many clinicians refer to “nephrotic range” proteinuria regardless of whether their patients have the other manifestations of the full syndrome because the latter are consequences of the proteinuria. NEPHROTIC SYNDROME Pathophysiology Proteinuria Hypoalbuminemia Edema Hyperlipidemia Cause (diagnosis and differential diagnosis) Systemic renal disease hepatitis B associated glomerulonephritis, Henoch-Schonlein purpura, systemic lupus erythematosus, diatetes mellitus, amyloidosis Idiopathic nephrotic syndrome Complications Infection Coagulat