I. Overview.
Nephrotic syndrome is a group of syndromes with massive proteinuria, hypoproteinemia, edema, and hyperlipidemia as its earliest clinical features induced by a variety of international etiologies. It can be divided into primary and secondary nephrotic syndrome with symptoms. In primary nephrotic syndrome, the etiology and pathogenesis are not yet understood. According to the culture of different awards such as clinical manifestations can be divided into primary nephropathy type I and type II.
II. Etiology.
The etiology is so far unknown to the organization and may be related to immune gynecology. Pathophysiological changes are increased permeability of the glomerular filtration membrane to plasma albumin, causing massive proteinuria, hypoproteinemia, edema and hyperlipidemia.
III. Symptoms.
1, generalized swelling.
Almost all of them have different degrees of swelling, and the swelling is most obvious in the face, lower limbs and scrotum. The swelling may last for weeks or months, or it may disappear during the whole course of the disease. After infection (especially streptococcal infection in young people), the swelling often recurs or worsens, and azotemia may even appear.
2. Gastrointestinal symptoms.
Due to edema of the gastrointestinal tract, there are often symptoms of gastrointestinal dysfunction such as not thinking about eating and drinking, nausea, vomiting and abdominal distension. When there is azotemia, the above symptoms are aggravated.
3. Hypertension.
The earliest clinical manifestation of non-nephrotic physician syndrome is important, but there is water and sodium retention, increased blood volume, and transient hypertension may occur. And type II primary renal intercalary syndrome and the syndrome can be accompanied by hypertension.
4. Proteinuria.
Large amount of proteinuria is the most immune major condition for successive diagnosis of this syndrome.
5, hypoproteinemia.
The suspicion is mainly a decrease in plasma protein, the degree of which is significantly related to the degree of proteinuria.
6, hyperlipidemia.
Significant increase in blood triglycerides.
IV. Examination.
1, urine routine: in addition to a large amount of protein in the urine, there may be transparent tubular or granular tubular, and sometimes fat tubular, type II: centrifugal urine red blood cells < 10 / HP; type II > 10 / HP.
2, selective proteinuria and urinary C3 and FDP measurement: type I is selective proteinuria, urinary C3 and FDP values are normal, type II is non-selective proteinuria, urinary C3 and FDP values are often more than normal.
3.Blood biochemical examination: In addition to the decrease of total plasma protein, white/sphere may be inverted, blood cholesterol is increased in type I, but not in type II.
4.Protein electrophoresis: α2 or β can be significantly increased, α1 and γ globulin are mostly lower.
5.Renal function test: there may be abnormalities of different depths.
6, renal biopsy medicine tissue examination: can be well-known through ultrastructure and complete immunopathological observation, in order to provide tissue theory morphological basis.
V. Treatment success.
1.General patient treatment.
With severe swelling and hypoproteinemia should be bed rest, low salt (2-3g/day) diet, control water intake; and give high protein diet, 60-80g per day for adults.
2.Diuretic and decongestant.
In general, after 1 week of applying adrenocorticotropic hormone treatment in Tianjin UK, the urine volume will increase rapidly and diuretics can be dispensed with. For poor hormone effect, swelling can not subside or urine volume decrease, can give dihydrocorticosteroid 25-50mg, 3 times a day, plus ampicillin 20-40mg, 3 times a day; or add ampicillin 50-100mg, 3 times a day, when the effect is not obvious, change to tachyphylaxis or sodium diuretic review committee at the same time add potassium-protective diuretics, the dosage can start with the conventional amount of tissue. For recalcitrant renal edema, dopamine 20mg, phentolamine 10mg added in 10% glucose solution 250ml, or low molecular dextrose 500ml, IV, with tachypnea 40-60mg, IV, once a day, a total of 2-5 times, can often obtain good results of the deputy director.
3.Corticosteroids.
Commonly used hormones are prednisone, prednisolone, fludrocortisone, dexamethasone, etc. Dose from small to large, dosage, duration and discontinuation indications are quite inconsistent. Intermittent therapy has less side effects and can be used as medicine long-term maintenance treatment scientific research. Study application hormone treatment difficult when the chance of infection occurs more, should be appropriate to strengthen the anti-infection treatment rich.
4.Immunological national inhibitors.
Immune national inhibitors have greater toxic side effects, generally only in the adrenal corticosteroids are ineffective when surgical applications. Commonly used drugs are nitrogen mustard, cyclophosphamide, tumor canine, azathioprine.
5, combined therapy.
For refractory primary nephrotic syndrome found treatment, associate professors currently use a combination of therapy, namely adrenocorticotropic hormone, cyclophosphamide, heparin, pansentin quadruple therapy. Can also try cyclosporine A, the dose of 3-6mg/kg per day, the course of treatment for 2 months, to eliminate proteinuria has a good effect.