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ID:19498726
大小:2.97 MB
页数:80页
时间:2018-10-02
《肾病综合征课件_13》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、肾病综合征NephroticSyndrome武汉大学第一临床学院刘红燕DefinitionNephroticsyndrome(NS)isdefinedbythepresenceoffollowing:Heavyproteinuria(>3.5g/d)Hypoalbuminemia(serumalbumin<30g/L)PeripheraledemaHyperlipidemia/hypercholesterolemiaMajorcausesofNS(primaryoridiopathic)Mini
2、malchangedisease(微小病变型)Mesangialproliferativeglomerulonephritis(系膜增生性肾小球肾炎)Focalsegmentalglomerulonephritis(局灶节段硬化性肾小球肾炎)Membranousglomerulonephritis(膜性肾病)Membranoproliferativeglomerulonephritis(膜增殖性肾小球肾炎/系膜毛细血管性肾小球肾炎)MajorcausesofNS(secondaryorsyste
3、mic)Antoimmune:systemiclupuserythematosus(SLE)Endocrine:diabeticnephropathyInfections:HepatitisB,C,HIVAllergenic:Henoch-SchonlenpurpuraNeoplastic:Hodgkin’sandnon-Hodgkin’slymphomas,multiplemyelomaOthers:Amyloidosis,Hereditarynephritis,medicationsPatho
4、physiologyHeavyprotinuriaHypoalbuminemiaEdemaHyperlipidemiaHeavyproteinuriaDamagetothecharge-selectivebarrierofGMB→ultrafiltrationofnegativelychargedalbuminDamagetothesize-selectivebarrierofGMB→passsageoflagermolecularproteinsProteinfiltration>reabsor
5、ptioncapacityoftubulesHeperperfusion/Hyperfiltrationfactors(hypertension,protein-richdiet)→proteinuriaincreaseConsequenceofurinarylossofplasmaproteinsSerumprotein↓orhypoalbuminemiaIgG/Complement↓→infectionCoagulationcomponentalternation(anticoagulants
6、↓)→thrombosisHormone-bindingproteins↓/metal-bindingproteins↓→endocrineormetabolicabnormalitiesLagerproteinsmayincreaseHypoalbuminemiaUrinarylossalbumincatabolism↑bytubulesMalnutritionduetoGIchangesEdemaReducedplasmaoncoticpressure(colloidosmoticpressu
7、re)Hypovolemia→renin-angiotensin-aldosteron↑;Sympatheticnervouseandvasopressionsystems↑PrimaryrenalNa+retension(non-plasmaHormoneeffectsonthekidney)HyperlipidemiaOneofthesentinelfeaturesofNSwithnumerousalterationsinlipidsprofiles(hypercholesterolemia,
8、hypertriglyceridemia,LDLandVLDL↑)OverproductionbytheliveroflipoproteinsDecreasedcatabolismoflipoproteinsandtriglycerideMinimalchangesnephropathy(MCD,微小病变型肾病)OverviewandTerminologyFirstdescribedin1913byMonkas“lipoidnephrosis”otherterms“nildisea
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