肾病综合征英文ppt课件[文字可编辑].ppt

Minimal change Disease Membranous Nephropathy Focal Segmental Glomerulosclerosis Membranoproliferative Glomerulonephritis Renal biopsy results Histologic Key Pathologic Features Pattern MCD ? LM ? Normal ? EM ? Foot process fusion MN FSGS MPGN ? LM ? Thickening of the GBM ? ? EM ? Subepithelial deposits of IgG ? LM ? Focal and segmental sclerosis of glomeruli ? EM ? Focal or diffuse foot process effacement. ? LM ? thickening of all capillary walls +cellular proliferation ? EM ? The double-contour or tram-track appearance represents interposition of mesangial cell with the GBM -subendothelial (type I) or intramembranous (type II) 36 COMPLICATIONS Due to ↓ oncotic pressure ? Hyperlipidaemia ? Hypovolemia ? Acute renal failure ? Anasarca ? risk of cellulitis, bacterial peritonitis with ascites ,large pleural effusions or pulmonary edema Due to loss of proteins in the urine ? Immunoglobulin ? ↑susceptibility to infection ? antithrombin III and proteins C and S ? Thromboembolism ? vit D – binding protein ? vit D deficiency ? Transferrin ? Iron deficiency anemia Treatment 38 Management of symptoms Oedema ? Low salt diet ? Diuretics ? serial measurement of body weight Proteinuria ? ACE inhibitors or ARBs ? Hypoalbuminaemia ? High protein diet not indicated ? 0.8 – 1 g/kg/day Ref: Up to date online 17.3. Nephrotic Syndrome The outlines Definition of Nephrotic syndrome Etiology Pathogenesis Clinical picture Diagnostic workup Pathological picture Complication Managements What is Nephrotic syndrome? 1.proteinuria (3.5g/day), 2.hypoalbuminemia (30g/L) 3. edema 4.hyperlipidemia Etiology 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 anaphyl