课件：内科学肾小球疾病丁小强.ppt

Main entities of NS Minimal change disease, MCD Focal and segmental glomerulosclerosis, FSGS Membranous glomerulopathy, MN MsPGN Membranoproliferative glomerulonephritis, MPGN Diabetic nephropahy, DN Amyloidosis,MM Complications---thrombosis  deep vein thrombosis  renal vein thrombosis Sudden onset of flank or abdominal pain Gross hematuria A left-sided varicocele Increased proteinuria Acute decline in GFR Paticularly common in MN/MPGN/Amyloidosis Other complications Protein malnutrition infection NS- treatment Specific treatment of the underlying disease Glucocorticoid, immunosuppression General measures of proteinuria control ACEI/ARB Nephrotic complications control and prevention Sensetivity of steroid prednisone(prednisolone)1mg/kg/d ? 8w negetive proteinuria remain positive relapse during taper sentsetive Steroid-dependent resistance NS complications control Edema Salt restriction 1-2g/d; judicious use of loop diuretics; Lipid lowering HMG CoA reductase Anticoagulation Indications: deep venous thrombosis, arterial thrombosis, pulmonary embolism Minimal change disease, MCD 80% of NS in children younger than 16 yo, 20% in adults Glomerular size and architecture normal by light microscopy IF microscopy negative for Ig and C3 EM characteristic diffuse effacement of foot processes of visceral epithelial cells MCD- proteinuria selectivity Selective proteinuria in children with albumin principally and minimal amounts of higher molecular weight protiens Selectivity poor in adults suggesting more extensive perturbation of membrane MCD-treatment Highly steroid-responsive Generally excellent prognosis Remission after 8 weeks of high-dose oral glucocorticoids: 90% in children and 50% in adults MCD-treatment (cont’d) Relapses common following withdrawal of glucocorticoids Alkylating agents reserved for steroid-resistant, steroid-dependent or frequently relapsing: CTX, chlorambucil, azathioprine, cyclosporine