《儿科学》Nephrotic Syndrome.pptVIP

 Pathophysiology  2. Hypoproteinemia: mainly albumin  3. Edema: nephrotic edema (pitting edema) Laboratory Exam 1. Urinary protein: 2+～4+ ● 24 h total urinary protein 50 mg/kg/d or 0.1g/m2/d ( the most are selective  proteinuria ) Laboratory Exam 3. Serum lipids↑  cholesterol(CH) ＞5.7mmol/L  triglycerides(TC)↑  LDL↑, VLDL↑ Laboratory Exam 4. ESR↑＞100 mm/h 5. Serum protein electrophoresis Albumen↓, α2-G↑,γ-G↓,  A/G inversion 6. Serum Ca++ ↓ Laboratory Exam  7. Serum complement: vary with clinical type? 8. Renal function  BUN serum Cr Complications 1. Infections ▲Acute infection is a major complication in children  with NS. It frequently trigger relapses  Complications▲ Often precipitated by viral infections Site: respiratory tract(URI),  skin, urinary tract and acute primary peritonitis Complications Due to: ★immunity lower (urinary loss of IgG, etc.) ★severe edema→malcirculation ★ protein malnutrition★ use steroid therapy  Complications 2. Electrolyte disturbances 2.1. Hyponatremia 2.2. Hypokalemia 2.3. Hypocalcemia Complications3. Thromboembolic phenomena ( Hypercoagulability ):  Potential arterial venous thrombosis, e.g. renal vein  thrombosis  Complications Due to: urinary loss of  antithrombinⅢ, hepatic fibrinogen synthesis↑, platelet aggregation↑etc.  Complications 4. Hypovolemia (Hypovolemic  shook)  5. Acute renal failure 6. Stunting Diagnosis 1. Diagnostic standard (P273) ●Four characteristics ●Excluding other renal disease (second NS) Diagnosis2. Clinical type: Simple type NS  Nephritic type NS  Ma