Nephrotic syndrome

一、Pathogeny

There are three kinds of primary , secondary and hereditary diseases . Primary NS belongs to primary glomerular disease and has many pathological types .

二、Symptoms

The most basic features of NS are massive proteinuria , hypoproteinemia , high swelling and hyperlipidemia , a group of clinical syndromes characterized by the so-called “ three highs and one low ” and other metabolic disorders .

1. Massive proteinuria

Proteinuria is the most important clinical manifestation in patients with NS , and it is also the most basic pathophysiological mechanism of nephrotic syndrome . A large amount of proteinuria refers to >3.5g/d of adult urine protein excretion . Under normal physiological conditions , the glomerular filtration membrane has a molecular barrier and a charge barrier , the protein content in urine increased , a large amount of proteinuria occurs when the absorption capacity of the proximal convoluted tubule is much higher than that of the proximal convoluted tubule .  

2. Hypoproteinemia

Plasma albumin decreased to <30g/L , a large amount of albumin is lost from urine during NS , which promotes the compensatory synthesis of albumin and the increase of tubular decomposition in liver . Hypoalbuminemia occurs when albumin synthesis in the liver is not increased enough to overcome loss and decomposition . In addition , NS patients with gastrointestinal mucosal swelling leading to poor appetite , insufficient protein intake , malabsorption or loss , also aggravate hypoproteinemia .

3. Swelling

Hypoproteinemia and plasma colloid osmotic pressure decreased at NS , the main reason for NS swelling is that the water enters the interstitial space from the lumen of vessel .

4. Hyperlipidemia

Hypercholesterolemia is mainly due to increased lipoprotein synthesis in the liver , but decomposition also plays a part in the surrounding circulation . Hypercholesterolemia is mainly due to metabolic disorders , and liver synthesis is a secondary factor .

三、Treatment

1. Generally treatment

All patients with severe swelling and hypoproteinemia should be kept in bed rest . After the swelling disappeared and the generally condition improved , the activity of getting up can be raised . A high protein diet with normal quantity of 0.8~1.0g/(kg/D) was given . Heat should be fully guaranteed . Daily weight should not be less than 30 to 35 kcal per kilogram . Swelling should be low salt ( less than 3g/d ) diet . In order to reduce hyperlipidemia , we should reduce the diet rich in saturated fatty acids ( animal fats ) .

2. Symptomatic treatment

(1) Diuresis detumescence

(2) Reduce protein in urine

3. Primary treatment

(1) Glucocorticoid therapy

(2) Cytotoxic agents

(3) Immunosuppressive agents