Nephrotic Syndrome (NS).ppt

 Nephrotic Syndrome (NS)  2.Hypoproteinemia (mainly albumin)  3.Edema: Nephrotic edema (pitting edema) Laboratory Exam 1.Urinary protein: 2+～4+ 24hr total urinary protein 0.1g/kg. ( The most are selective proteinuria. ) 1.2 Diet  Hypertension and edema: Low salt diet (2gNa/ day) or salt-free diet. Severe edema: Restricting fluid intake.  Increase proteins properly: 2g/(kg·day) While undergoing the corti-costeroid treatment: Give VitD 500~1000iu/day (or Rocaltrol)and calcium.  1.3 Prevent infection 1.4 Diuretics Not requires diuretics usually.＊HCT 2~5mg/(kg · day)＊Antisterone 3~5mg/(kg · day)＊Triamterene  Attention: Volume depletion, disorder of electrolyte and embolism.  Apparent edema:  Give low molecular dextran 10~15ml/(kg·time);[+Dopamine 2~3ug/(kg·min) and/or Regitine 10mg +Lasix 1~2mg/kg]. * *  Definition NS is an accumulation of symptoms and signs and is characterized by proteinuria, hypoproteinemia, edema, and hyperlipidemia.  The vast majority patients (90% of cases) with NS of childhood are primary. In children under age 5 years the disease usually takes the form of idiopathic (primary) NS of childhood (nil disease, lipoid Nephrosis). Conditions Of Attack Second only to acute nephri-tis. Incidence age: At all ages, but most commonly between 2~5 years of age. Type 1.Clinical type Simple NS ; Nephritic NS 2.Response to steroid therapy (P331) The initial response to cortico- steroids is a guide to prognosis.  (1)?Total effect (2)? Partial effect (3)? Non-effect 3. Pathologic type (P328) Minimal change disease, MCD: 80% of patients. Pathogenesis The primary disorder is an increase in glomerular permea- bility to plasma proteins. ▲Foot processes of the visceral epithelium of the GBM.  1.The const