内科学教学课件：Nephrotic syndrome.pptVIP

【complication】 1.infection→pro.malnutrition;disturbance of immune; glucocorticoid 2.thrombosis→blood concentrate; hyperlipidemia;anticoagulation-fibrinolytic sys.disorder; lasix; glucocorticoid; Plt function↑ 3.Acute renal failure→decreased effective circulating blood volume→renal perfusion↓ 4. Protein lipid metabolism disturbance →hypoproteinuria→ metal unite pro.↓; endocrine hormones; drug unite pro. ↓ 【diagnosis】 1.Confirm NS exist; 2.Secondary NS must be excluded; biopsy should de performed; 3.Complication diagnosis; 【differential diagnosis】 Distinguish the reasons of secondary NS: 1.Allergic purpura 2.Systemic lupus erythematosus 3.Nephritis relating HBV 4.Diabetic glomeruli sclerosis 5.Renal amyloidosis 6.Myeloma nephropathy 【treatment】 1.General treatment: Rest; Diet: essential amino acids; limit salt (3g/d); advocate unsaturaed fatty acid soluble vitamin 2.Suit the remedy to the case: Diuretics→ more shortcoming, so it’s not administrated prevailing; Reduce proteinuria → ACEI/ARB Increasing plasma osmotic pressure 3.Main treatment: Inhibit inflammation immune reaction ⑴ glucocortical hormone: Inhibit inflammation immune reaction, aldosterone ADH (antidiuretic hormone), ①initiate with enough dose →prednisone 1 mg/kg·d for 8～12 weeks ② the dose should be reduced slowly and regularly→10% of the primary dose should be reduced every 1 or 2 weeks. Especially at the dose 20 mg/d ③long term maintain→10mg qd/ 20mg qod for half a year to reduce the side effect The principle should be obeyed: The side effect including infection, drug-relative diabetes mellitus, osteoporosis even abacterial femoral head necrosis Response to glucocortical hormone→ steroid-sensitive、steroid-depended 、steroid-resisted ⑵cellular toxics: CTX→ total 6～8g; side effect (medulla inhibit; hepatic damage; sex gland inhibit; trichomadesis; alimentary reaction, hemorrhage cystitis) ⑶ciclosporin: Disad