肾病综合征(英文）-儿科课件[精品].ppt

Diagnosis and differential diagnosis Idiopathic or secondary MCN or non-MCN importance of renal biopsy * Treatment of NS General principle Anticoagulation Corticosteroids Immunosuppressive agents Chinese traditional medicine * General principle Low salt diet (2g/d), appropriate protein intake (2-3g/kg/d) Avoiding infection Diuresis: Thiazide –DHCT 2mg/kg/d Antisterone 2-4mg/kg/d Dextran 10-20ml/kg followed by Lasix at 2mg/kg * Anticoagulation Dipyridamole: 5mg/kg/d Heparin: 0.5-1mg/kg/d×7-10d Warfarin: initial dose: 2.5mgTid×3-5d Subsequent dose: 2.5-10mg/d based on PT * Corticosteroids Short course: 2mg/kg/d→ pro(-) 1.5mg/kg/qod×4w → no taper, Course 8w, Relapse rate (1y)= 81% Standard course: 2mg/kg/d×4w → 2mg/kg/qod×4w → taper, Course 6m, Relapse rate (1y)= 61% Long course: 2mg/kg/d×4-6w → 2mg/kg/qod×4-6w → taper, Course 9-12m, Relapse rate (1y)= 31% * Steroids treatment response high response: 4w→proteinuria(-) response: 8w→proteinuria(-) partial response: 8w→proteinuria(+/++) steroid dependent: responsive but require high dose relapse: proteinuria(-)→proteinuria(++ or up) frequent relapse: relapse twice/6m or trice/1y * Side effect of steroids Growth failure Hypertension posterior sublenticular cataracts Osteoporotic bone disease Gastric ulcer→hematesis? * Immunosuppressive agents(1) CTX: 2-2.5mg/kg/d×8-12w, maxium single dose 0.1, maxium cumulative 200-250mg/kg Chlorambucil: 0.2mg/kg/d×8-12w, maxium single dose 6mg, maxium cumulative dose 12-16mg/kg Cyclosporin A: 5-6mg/kg/d×2-6m, keep blood concentration at 50-150ng/ml * Immunosuppressive agents(2) Vincristine: 0.075mg/kg weekly, maxium single dose2mg 6-TG(6-thioguanine): 2mg/kg/d×8w, maxium single dose75mg nitrogen mustard: 0.1mg/kg/d×4d, may be repeated 1 month later azathioprine: 1-2mg/kg/d×8-12w * New immunosuppressive agents Myco