肾病综合征(英文）-儿科课件PPT.pptVIP

Diagnosis and differential diagnosis Idiopathic or secondary MCN or non-MCN importance of renal biopsy Nephrotic Syndrome Department of Prdiatrics, Tongji Hospital Nephrotic Syndrome Definition Etiology Pathology Pathophysiology Clinical Manifestation Laboratory Data Diagnosis Therapy and Prognosis Male 4 years and 6 months old Complaint of edema and oliguria Definition: Nephrotic Criteria Massive proteinuria ISKDC: 40mg/m2/hr CAN: +++ trice/2w or 50-100mg/kg/24hr Mendoza: Urine Protein/Cr ≥2.0 Hypoalbuminemia: 30g/L Hyperlipidemia:Cholesterol 5.72mmol/L Edema Definition: Nephritic Criteria Hematuria: RBC ++( 10 /HP), trice/2w Hypertension: 130/90 mmHg in children over 7y 120/80 mm Hg in 3-6y children 110/70 mm Hg in 3y children Azotemia:BUN6.4mmol/L, Cr 133umol/L Hypocomplementemia: C30.8/L Secondary NS : DIAMOND Infection: APSGN, HBV, HIV,shunt nephropathy, reflux nephropathy, leprosy, syphilis, schistosomiasis, hydatid disease Drug,Toxic,Allegy: mercury, snake venom, vaccine, pellicillamine, Heroin,gold, NSAID, captopril, probenecid, volatile hydrocarbons Neoplasma: Hodgkin’s disease, carcinoma ( renal cell, lung, neuroblastoma, breast, and etc) Autoimmune or collagen-vascular diseases: SLE, Hashimoto’s thyroiditis, EMC, HSP, Vasculitis Genetic Disease: Alport syn., Fabry syn., Nail-patella syn., Sickle cell disease, Amyloidosis, Congenital nephropathy Metabolic disease: Diabetes mellitus Others: Chronic transplant rejection, congenital nephrosclerosis Pathology Primary NS: Minimal Change Nephropathy (MCN): 80% Mesangial proliferative glomerulonephritis (MsPGN): 10-12% Focal segmental glomerulosclerosis (FSGS): 5% Others: Membranous Nephropathy (MN) ―most common in adults Membrane proliferative glomerulonephritis (MPGN): 2-5% Cresent glomerulonephritis: rare, Crescent glomeruli 50% Secondary NS: dependent on causes, APSGN, MN, FSGS, MsPGN or MPGN Minimal Change Nephropathy (MCN ) Little or n