儿科学ppt课件（重庆医科大学）15ns肾病综合征.pptVIP

Nephrotic Syndrome,NS肾病综合征;Contents;Definition;NS AGN;General Information;Classification of NS;Primary Nephrotic Syndrome 原发性肾病综合征 (PNS);Classification of PNS;Sensitivity to steroid therapy: Steroid-sensitive NS (SSNS)激素敏感型NS Steroid-resistant NS (SRNS)激素耐药型NS Steroid-dependant NS (SDNS)激素依赖型NS;Pathologic classification: Minimal change NS (MCNS): Non-minimal change NS： Diffuse mesangial proliferation (DMP)弥漫系膜增生性肾炎 Focal segmental glomerulosclerosis (FSGS)局灶节段肾小球硬化 Membranoproliferative glomerulonephritis (MPGN)膜增生性肾小球肾炎 Membranous glomerulopathy (MN)膜性肾病 ;;Etiology and Pathogenesis;glomerular filtration membrane ;分子屏障（孔径屏障）;静电屏障;Electrostatic Barrier; Pathology;FSGS;Pathophysiology; Hypoalbuminemia Caused by Lost from urine Raise of proteolysis by tubular Loss of albumin is more than synthesis in liver hypoalbuminemia: Alb〈 25g/L ;Edema Caused by Decreased plasma?osmotic pressure The activation of the renin-angiotensin–aldo-sterone?? system (RAAS) increase Characteristic: pitting edema凹陷性水肿 ;Hyperlipidemia Caused by Increased compensatory synthesis by liver Lipid conversion disorder (LDL) lost from urine (HDL) Serum Cholesterol5.7mmol/L ;肾病综合征病理生理; impairment of GBM;Edema The most common complain Feature : pitting, dependent edema Site : first periorbital edema, proceed into scrotum, limbs , ascites, pleural effusions ; Proteinuria Glomerular capillary wall permeability Quantity is greater than the tubular resorption capacity Heavy proteinuria : 24-hours urine protein quantitation≥50mg/Kg urine protein to creatinine ratio ＞2.0 ;Hypoalbuminemia Result of urinary protein loss and low protein synthesis Serum albumin25g/L ;Hyperlipidemia Result of increased compensatory synthesis and lipid metabolism disorder Serum cholesterol 5.7mmol/L, most serum lipoproteins increase（ Ch↑, TG↑, LDL ↑, HDL↓ ）;Clinical classification of PNS;Complications;Complications;Pathogen: viral , bacterial, particularly streptoccocus pneumoniae, fungi S