北京医院-Nephrotic Syndrome教学课件.ppt

IgA肾病 紫癜性肾炎 思考题 肾脏病理与临床的关系  Blood S.Cholesterol S.Albumin S. A/G ratio - reversal S.Creatinine Bl. Urea S . C3 and C4 levels Diagnosis 4 characteristics Renal Biopsy - indications Age of onset 1 yr. or 15 yrs. Features suggestive of disease other than MCNS [macroscopic hematuria, HTN, Low C 3, renal failure] Steroid non-responder Frequent relapses Steroid dependency Secondary steroid resistance Prior cytotoxic therapy DD – Protein losing enteropathy – Hepatic failure – CHF – Acute or chronic GN – PEM  Secondary Nephrotic Syndrome ? Vasculitides – SLE, Sarcoidosis, HSP, Rheumatoid arthritis, Wageners granulomatosis Goofpasteur syndrome ? Metabolic – Amyloidosis, Myxoedema, DM ? Infections – Syphilis, Shunt nephritis, Hepatitis B and C, CMV, HIV ? Parasitic – Plasmodium malariae, Toxoplasma, Syphilis ? Drugs – Gold, Mercury, Penicillamine, Lithium, Ethosuccimide, NSAIDS ? Malignancies – Lymphomas, Carcinomas ? Congenital / Inherited – Alport syndrome, Nail - Patella syndrome ? MINIMAL CHANGE NEPHROTIC SYNDROME FOCAL SEGMENTAL GLOMERULOSCLEROSIS MEMBRANOUS NEPHROPATHY MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS ? ? ? ? Type I Type II FREQUENCY ? ? ? ? ? Children 75% 10% 5% 10% 10% Adults 15% 15% 50% 10% 10% Clinical Manifestations ? ? ? ? ? Age (yr) 2–6, some adults 2–10, some adults 40–50 5–15 5–15 Sex 2 : 1 male 1.3 : 1 male 2 : 1 male M-F M-F Nephrotic syndrome 100% 90% 80% 60% 60% Asymptomatic proteinuria 0 10% 20% 40% 40% Hematuria 10–20% 60–80% 60% 80% 80% Hypertension 10% 20% early Infrequent 35% 35% Rate of progression to renal failure Does not progress 10 yr 50% in 10–20 yr 10–20 yr 5–15 yr MINIMAL CHANGE NEPHROTIC SYNDROME FOCAL SEGMENTAL GLOMERULOSCLEROSIS MEMBRANOUS NEPHROPATHY MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS ? ? ? ? Type I Type II Associated conditions Allergy? Hodgkin disease, usually none None Renal vein thrombosis, cancer, SLE, hepatitis B None Partial lipodystrophy Laboratory Findings Manifestation