Nephrotic Syndrome

Nephrotic Syndrome (NS) ตตตตตตตตตตตตตตตต 4 ตตตตตตตตตตตตตตตต 1. Proteinuria 2. Hypoalbuminemia 3. Edema 4. Hyperlipidemia (TG,Ch สสส) สสสสส lipoprotein lipase สสสสสสสสสสสสสสสสส fatty acid สสสสสสสสสสสสสสสสสสส สสสสสสสสสสสสส fatty acid สสสสสสสสสสส สสสสสสสสสสสสสส lipid สสสสสสสสสสสสสสสสสสสสสสส 5 สสส สสสสสสสสสสสส สสสสสสสสสสสส สสสสสสสส idiopathic Nephrotic Syndrome สสสสสสสสสสสสสสสสสสสสสสสสสสสสส 2 สสสส สสสสส สสสสสสสสสสสสสส สสสสสสสสสสสสสส สสสส 2 – 5 สส ตตตตตตตตตตต 2 ตตตตตต 1. Primary nephrotic syndrome (idiopathic NS, Simple NS) 2. Secondary nephrotic syndrome (Nephritic NS) ตตตตตตตตต สสสสสสสสสสสสสสสสสสสสสสสสสสสสส สสสสสสสสสสสสสสสสสสสสสสสสสสสสสสสสสสส สสสสสสสสสสสสสสส ตตตตตตตตตตตต 1. สสสสสสสสสสสส glomerular basement membrane(GBM) สสสสสสสสสสสสสสสส สสสส

Upload
totoil22
Category

Documents
view
235
download
11

Embed Size (px):

description

Nephrotic Syndrome

Transcript of Nephrotic Syndrome

Nephrotic Syndrome (NS) 4 1. Proteinuria2. Hypoalbuminemia3. Edema4. Hyperlipidemia (TG,Ch ) lipoprotein lipase fatty acid fatty acid lipid

5 idiopathic Nephrotic Syndrome 2 2 5

2 1. Primary nephrotic syndrome (idiopathic NS, Simple NS)2. Secondary nephrotic syndrome (Nephritic NS)

1. glomerular basement membrane(GBM) Nephrotic syndrome2. GBM membrane

GBM evidence immune machanisms

1. proteinuria 2. Hypoalbuminemia : albumin oncotic pressure shift fluid intra extra cellular compartment albumin shift vascular interstitial 3. Edema(pitting edema) : loss feedback RAAS 4. Hyperlipidemia : TG, Ch, LDL, VLDL

oliguria (periorbital swelling) (Anasarca): Pallid, anorexia, fatigue, abdominal pain, dirrhea

1. Urinary protein 2+ 4+ 24 0.1 /kg2. Total serum protein 30g/LAlbumin 20 g/L3. Cholesterol 220 mg/dl4. ESR(Erythrocyte sedimentation rate) 100 mm/hr5. Serum protein electrophoresis: Albumin, A/G inversion 6. Renal function7. Serum complemen

Complications1. Infection (immunoglobulin) 2. Electrolyte disturbancesa. Hyponatremiab. Hypokalemiac. Hypocalcemia3. Hypercoagulation 4. Hypovolemic shock5. Acute renal failure(pre renal)

4 primary secondary NS

1. a. b. Hypertension edema: 2g/kg/day steroid VitD 500-1000 IU/day Cacium steroid c. Diuretic: - HCTZ 2-5 mg/kg/day Antisterone 3-5 mg/kg/day Furosemide 1mg/kg IV drip + Albumin IV infusion 1 mg/kg over 1 hr ( pt hypoalbuminemia)Apparent edema: dextran 10-15/kg/day [+ Dopamine 2-3 ug/kg/day]

2. Corticosteroid therapya. Short-coursei. Prednisone 2 mg/kg/day (Max. 60 mg/day) 3-4 4 wkii. Maintenance: Prednisone 1.5 mg/kg/day single dose 4 wkb. Middle & long coursei. Induction of remission: Prednisone 1.5-2 mg/kg/day (Max. 60 mg/day) 4 wk ii. After maintenance: Maintenance: Prednisone 1.5 mg/kg/day single dose 4 wk 2.5-5 mg/2wk 3. a. corticosteroid b. Immunosuppresive agentsi. Cyclophosphamide(Cytoxan) 2 mg/kg/day 8-12 wkii. CB(Chlorambucil)iii. Vincristine & Levamisole4. Impulsivea. MP 15-30 mg/kg IV + b. CTXc. Cyclosporin Ad. Anticoagulants(Heparin)e. Alleviar proteinuria: ACEI