内科学肾病综合征(英文)
56页1、Nephrotic Syndrome,Learning objectives,Clinical manifestation, pathology and treatment of nephrotic syndrome Pathophysiology of nephrotic syndrome Complications of nephrotic syndrome,Outline,Definition Pathophysiology Pathology and clinical manifestation Complications Diagnosis and differential diagnosis Treatment,Mr. O,19 years old university student Noticed foaming urine during the past 3-4 weeks Puffing face, swelling feet for 1 week Had gain 9 kg body weight Shoes too tight to wear Slightly
2、fatigue and SOB, otherwise normal,Figure 1. Nephrotic edema.,Figure 2. Nephrotic edema.,Diagnosis:,Proteinuria: 3.5g/d Hypoalbuminemia: SAlb 30g/L Edema Hyperlipidemia,Pro +,What will you do for Mr. O ?,What will you do ?,Urine routine 24h urinary protein Kidney function Liver function and serum albumin Lipids ,Lets go back to Mr. O,Urine protein +, RBC (-), WBC (-) 24h urinary protein 7.8g Normal kidney and Liver function Serum albumin 20g/L Total cholesterol 10.2mmol/L,Mr. O was diagnosed with
3、 nephrotic syndrome,Proteinuria (albuminuria),Figure 3.,Hypoalbuminemia,Albumin Immunoglobulins Metal binding proteins Erythropoietin urinary loss Transferrin Complement deficiency Coagulation components,Mechanisms leading to nephrotic hypoalbuminemia,Hyperlipidemia,Most NS patients have elevated levels of total and low-density lipoprotein (LDL) cholesterol with low or normal high-density lipoprotein (HDL) cholesterol . Lipoprotein (a) Lp(a) levels are elevated as well. Nephrotic patients often
4、have a hypercoagulable state and are predisposed to deep vein thrombophlebitis, pulmonary emboli, and renal vein thrombosis.,Mechanisms of Hyperlipidemia,Increased hepatic synthesis of LDL, VLDL and lipoprotein (a) in response to hypoalbuminemia Urinary loss of HDL Enzymatic changes with abnormal lipid biosythesis and degradation,Edema,Two different major mechanisms: In the classic theory, proteinuria leads to hypoalbuminemia, a low plasma oncotic pressure, and intravascular volume depletion. Su
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