肾病综合征英文 课件.ppt

Nephrotic Syndrome;The outlines;What is Nephrotic syndrome?;Types of nephrotic syndrome (1) Idiopathic nephrotic syndrome: Etiology of the disease is unknown, accounting for approximately 90% of nephrosis in childhood. (2) Secondary nephrosis: NS resulted from systemic disease such as anaphylactoid purpura, systemic lupus Erythematosus (SLE), and so on. ;Etiology;Etiology;Etiology;Etiology;Pathogenesis;(1) Proteinuria: Massive proteinuria is the most chief characteristics of nephrosis resulting from an increase in glomerular capillary wall permeability to plasma protein. The mechanism may be related to ①Molecular barrier injury :holes on GBM become larger; ②Charge barrier injury: loss of negative ; (2) Hypoproteinemia ①Plasma protein is lost by urine; ②Protein catabolism ↑, so total plasma protein concentration↓, especially albumin. ;(3)Hyperlipidemia All serum lipid (cholesterol, triglycerides) and lipoprotein levels are elevated. A. Hypoproteinemia stimulates generalized protein synthesis in the liver, including the lipoprotein; B. Lipid catabolism is diminished. ;(4) Edema A. Hypoalbuminemia leads to a decrease in plasma osmotic pressure, which permits the translation of fluid from intravascular compartment to interstitial space. B. The intravascular volume ↓make renal perfusion pressure ↓activating rennin-angiotensin-aldosterone system, which stimulates distal tubular reabsorption of sodium↑. C. Reduced intravascular volume also stimulates the release of antidiuretic hormone, which enhances there absorption of water in the collecting duct. D. Because of plasma osmotic pressure ↓, the sodium and water enter interstitial space ;Pathology;(1) Minimal change disease (78%), the glomeruli appear normal. The epithelial cell foot processes fused. More than 95% of children with MCD, and better responding to corticosteroid therapy. Light Microscopy Either normal or reveals only mild mesangial cell proliferation EM Diffuse fusion of the epithealial ce