Nephrotic syndrome

Introduction

Nephrotic syndrome (referred to as nephropathy) is due to increased glomerular basement membrane permeability, resulting in a large number of plasma protein from the urine caused by the loss of a clinical syndrome. The main features are: a large number of proteinuria, hypoalbuminemia, severe edema and hypercholesterolemia.

Anatomy of the urinary system

Anatomy of the urinary system atlas

Nephrotic syndrome is a large number of proteinuria, hyperlipidemia, hypoalbuminemia, and systemic edema of varying degrees is characterized by clinical syndrome. Christian in 1932 the first application of nephrotic syndrome (nephroticsyn-drome) to the term, to summarize a variety of renal pathological damage caused by severe proteinuria and a corresponding group of clinical manifestations, performance and renal disease is very similar, Hence the name nephrotic syndrome. Clinical features: three high and one low, that is, a large number of proteinuria (≥ 3.5g / d), edema, hyperlipidemia, plasma protein low (≤ 30g / L). Severe cases will have serous effusion, anuria performance.

Nephrotic syndrome occurs at any age, but more prevalent in children, 1 year and a half to 4 years old the most common. Young males have a good history, but in older patients the sex distribution is more even.

Although nephrotic syndrome as a group of clinical syndrome with a common pathological changes, clinical manifestations and metabolic changes, and even treatment also have a common law, but because this is a variety of etiology, pathology and clinical disease caused by a group of integrated Levy, so the pathogenesis and treatment and so has its own characteristics. Nephrotic syndrome and fever, headache and other terms, should not be used as the final diagnosis of the disease.

Causes

1. Immune response: circulating immune complex deposition; in situ immune complex formation. In this case,

2. Inflammatory reaction: mononuclear macrophages neutrophils, eosinophils, platelets, inflammatory mediators and other violations of the kidneys. Eventually leading to glomerular filtration membrane molecular barrier and charge barrier damage, glomerular filtration membrane on plasma protein (mainly albumin) permeability increased, caused by increased protein content in the urine, when more than the distal convoluted tubules Back to the amount of absorption, the formation of large amounts of proteinuria.

diagnosis

Diagnosis can be prompted by clinical manifestations and laboratory findings, renal biopsy confirmed. Severe proteinuria is necessary for diagnosis. The distinction between nephropathy and nonrenal range proteinuria is artificial. However, the disease mainly affects the extra-ocular vascular system or tubulointerstitium often does not produce very severe proteinuria.

Renal failure is a rare manifestation in nephrotic syndrome, but can occur after prolonged disease. However, patients with nephrotic syndrome due to secondary causes often present with renal insufficiency at onset or shortly thereafter. Nephritis patients with severe proteinuria often suggest disease progression, so for the prognosis of adverse signs.

Patients should be screened for common underlying systemic diseases (such as diabetes, amyloidosis, multiple myeloma, SLE). In weight loss and the elderly, should be considered malignant diseases and drug-related reasons.