内科学教学课件：Nephrotic Syndrome
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Sites: Pathogens:
(2) Thromboembolic events
Reduced effective blood volume Hyperlipidemia Altered clotting factors level
Thrombosis → embolus → embolism Could be life-threatening.
(3) Acute renal failure
Reduced renal perfusion Severe edema of renal interstitium Drug (harmful to kidney) therapy: Acute bilateral thrombosis of renal vein Could be idiopathic
component, complement → Hypercoagulable state, iron, copper, zinc deficiency, infection.
（3） Edema
Proteinuria→hypoalbuminemia→plasma oncotic pressure↓→edema
Classifications and common causes for nephrotic syndrome
Children
youth
aged peo百度文库le
Primary MCD
MsPGN MPGN FSGS
MN
MCD
Secondary Henoch-Schonlein purpura HBV－associated Congenital
Lupus nephritis Henoch-Schonlein purpura HBV－associated
Diabetic nephropathy Amyloidosis multiple myeloma
3. Pathophysiology （1） Proteinuria
Electrical charge barrier disturbance: MCD, selective proteinuria Size barrier disturbance: non-selective proteinuria
（2） Hypoalbuminemia
Secondary to protein loss in urine. Liver could not produce enough albumin to supplement.
Increased albumin catabolism
Loss of other proteins: IgG, metal-binding proteins, coagulation
Reduced catabolism of these compounds.
4. Complications
(1) Infection
Malnutrition Disturbance of immune function(WBC function, complememt loss) Therapy of corticosteroid
Increased salt and water retention: from RAS↑
（4） Hyperlipidemia:
Increased hepatic synthesis of cholesterol, triglycerides and lipoproteins in the process of albumin synthesis.
necessary for diagnosis.
2. Causes
(1) Primary glomerular diseases
Pathological classifications of NS: Minimal change disease (MCD) Membranous nephropathy (MN) Mesangial proliferative GN (MsPGN) Mesangial capillary GN
lymphoma, other cancers.
Drugs--- NSAIDs（non-steroidal antiinflammatory drugs） Hereditary disorder---Alport's syndrome Allergens---bee sting, snake bite, pollen Infections---SBE, HBV, HIV infection
Nephrotic Syndrome (P633)
a group of signs and symptoms, not a single disease (base on extent of proteinuria, not on etiology) 1. Features Large amount of proteinuria, > 3.5g/d Hypoalbuminemia: serum albumin < 30g/L Hyperlipidemia Edema -- Massive proteinuria and hypoalbuminemia are
(membrane proliferative GN, MPGN) Focal segmental glomerular sclerosis (FSGS)
(2) Systemic diseases and other disorders: Metabolic disease---Diabetes Mellitus, amyloidosis Autoimmune disease---SLE, Henoch-Schonlein purpura Malignancy---Hodgkin' disease, multiple myeloma,
(4) Severe metabolic disturbance
(2) Thromboembolic events
Reduced effective blood volume Hyperlipidemia Altered clotting factors level
Thrombosis → embolus → embolism Could be life-threatening.
(3) Acute renal failure
Reduced renal perfusion Severe edema of renal interstitium Drug (harmful to kidney) therapy: Acute bilateral thrombosis of renal vein Could be idiopathic
component, complement → Hypercoagulable state, iron, copper, zinc deficiency, infection.
（3） Edema
Proteinuria→hypoalbuminemia→plasma oncotic pressure↓→edema
Classifications and common causes for nephrotic syndrome
Children
youth
aged peo百度文库le
Primary MCD
MsPGN MPGN FSGS
MN
MCD
Secondary Henoch-Schonlein purpura HBV－associated Congenital
Lupus nephritis Henoch-Schonlein purpura HBV－associated
Diabetic nephropathy Amyloidosis multiple myeloma
3. Pathophysiology （1） Proteinuria
Electrical charge barrier disturbance: MCD, selective proteinuria Size barrier disturbance: non-selective proteinuria
（2） Hypoalbuminemia
Secondary to protein loss in urine. Liver could not produce enough albumin to supplement.
Increased albumin catabolism
Loss of other proteins: IgG, metal-binding proteins, coagulation
Reduced catabolism of these compounds.
4. Complications
(1) Infection
Malnutrition Disturbance of immune function(WBC function, complememt loss) Therapy of corticosteroid
Increased salt and water retention: from RAS↑
（4） Hyperlipidemia:
Increased hepatic synthesis of cholesterol, triglycerides and lipoproteins in the process of albumin synthesis.
necessary for diagnosis.
2. Causes
(1) Primary glomerular diseases
Pathological classifications of NS: Minimal change disease (MCD) Membranous nephropathy (MN) Mesangial proliferative GN (MsPGN) Mesangial capillary GN
lymphoma, other cancers.
Drugs--- NSAIDs（non-steroidal antiinflammatory drugs） Hereditary disorder---Alport's syndrome Allergens---bee sting, snake bite, pollen Infections---SBE, HBV, HIV infection
Nephrotic Syndrome (P633)
a group of signs and symptoms, not a single disease (base on extent of proteinuria, not on etiology) 1. Features Large amount of proteinuria, > 3.5g/d Hypoalbuminemia: serum albumin < 30g/L Hyperlipidemia Edema -- Massive proteinuria and hypoalbuminemia are
(membrane proliferative GN, MPGN) Focal segmental glomerular sclerosis (FSGS)
(2) Systemic diseases and other disorders: Metabolic disease---Diabetes Mellitus, amyloidosis Autoimmune disease---SLE, Henoch-Schonlein purpura Malignancy---Hodgkin' disease, multiple myeloma,
(4) Severe metabolic disturbance