肾病综合征课件_13.ppt

肾病综合征Nephrotic Syndrome 武汉大学第一临床学院 刘红燕 Definition Nephrotic syndrome (NS) is defined by the presence of following: Heavy proteinuria (3.5g/d) Hypoalbuminemia (serum albumin 30g/L) Peripheral edema Hyperlipidemia / hypercholesterolemia Major causes of NS (primary or idiopathic) Minimal change disease (微小病变型） Mesangial proliferative glomerulonephritis （系膜增生性肾小球肾炎） Focal segmental glomerulonephritis （局灶节段硬化性肾小球肾炎） Membranous glomerulonephritis （膜性肾病） Membranoproliferative glomerulonephritis （膜增殖性肾小球肾炎/系膜毛细血管性肾小球肾炎） Major causes of NS (secondary or systemic) Antoimmune: systemic lupus erythematosus (SLE) Endocrine: diabetic nephropathy Infections: Hepatitis B, C, HIV Allergenic: Henoch-Schonlen purpura Neoplastic: Hodgkin’s and non-Hodgkin’s lymphomas, multiple myeloma Others: Amyloidosis, Hereditary nephritis, medications Pathophysiology Heavy protinuria Hypoalbuminemia Edema Hyperlipidemia Heavy proteinuria Damage to the charge-selective barrier of GMB →ultrafiltration of negatively charged albumin Damage to the size-selective barrier of GMB →passsage of lager molecular proteins Protein filtration reabsorption capacity of tubules Heperperfusion/Hyperfiltration factors (hypertension, protein-rich diet) →proteinuria increase Consequence of urinary loss of plasma proteins Serum protein ↓or hypoalbuminemia IgG/Complement ↓→infection Coagulation component alternation (anticoagulants ↓)→thrombosis Hormone-binding proteins ↓/metal-binding proteins ↓→endocrine or metabolic abnormalities Lager proteins may increase Hypoalbuminemia Urinary loss albumin catabolism ↑ by tubules Malnutrition due to GI changes Edema Reduced plasma oncotic pressure (colloid osmotic pressure) Hypovolemia →renin-angiotensin-aldosteron ↑ ; Sympathetic nervouse and vasopression systems ↑ Primary renal Na+ retension (non-plasma Hormone effects on the kidney) Hyperlipidemia One of the sentinel features of NS with numerous alterations in lipids profiles (hypercholesterolemia