天津医科大学内科学课件 Nephrotic syndrome.pptVIP

* * * * * outline Definition The causes of NS The complications and general therapy Clinicalpathology entity Minimal chang nephrotic syndrome (MCD) Focal and segmental glomerulosclerosis (FSGS) Collapsing glomerulopathy (CG) Mesangial proliferative glomerunephritis (MSPGN) Membranous nephropathy (MN) Membranoproliferative glomerulopathy Some glomerulopathies secondary to other diseases Lupus nephritis Hepatitis B virus associated glomerulonephritis (HBV-GN) Diabetic nephropathy (DN) Amyloidosis * * lupus nephritis SLE affected multiple organs,including the kidney,which is a major source of patient morbidity and mortality.clinical renal disease occurs in approximately 50% of SLE patients.virtually all patients are found to have renal injury if a renal biopsy is performed. * * Features of lupus nephritis Prevalence: estimated at 4~ 250 cases per 100.000 populations. Predoninance: higher in blacks and Asian-Americans than among whites. Iincidence : SLE occurs in all age groups and both sexes,it is far more common in women of reproductive age(female:male=8:1to 13:1) Its incidence is markedly reduced in childhood and older age populations,in which the female preponderance is no longer evident. Manifestation: nephrotic and /or nephritic syndrome All of the recognized clinical syndromes associated with glomerulopathies can occur in SLE. The nephritic syndrome with a “nephritic” sediment is most common,it can be the persisting manifestation of a patient with SLE without any other systemic manifestations. * * Laboratory findings(LN) Immunologic markers: a array of antibodies(ANA,ds-DNA.etc) and C3,C4 Urine findings: persistent proteinuria 500mg/d,or cellular casts:granular,tubular,or mixed Hematologic involvement: anemia,leukopenia,lymphopenia, thrombocytopenia * * Table. original WHO Classification of Lupus Nepritis Class I Normal glomeruli ClassⅡ Purely mesangial disease ClassⅢ Focal segmental pr