20090407223831_876801491057 - Nephrotic Syndrome(NS Qiang...

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Nephrotic Syndrome (NS) Qiang Yao Renal Division, Renji Hospital Shanghai 2nd Medical Universigy
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Introduction Etiology Pathophysiology Pathology and clinical feature Complications Diagnosis and differential diagnosis Treatment
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Diagnosis: Proteinuria: >3.5g/d Hypoalbuminemia: SAlb <30g/L Edema; Hyperlipidemia. Pro ++++
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Hypoproteinemia Albumin Immunoglobulins Metal binding proteins Erythropoietin urinary loss Transferrin Complement deficiency Coagulation components
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Hyperlipidemia Hypercholesterolemia Hypertriglyceridemia Low-density lipoproteins (LDL) Very low- density lipoproteins (VLDL)
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chemical composition of plasma lipoprotein (%) CM VLDL LDL HDL protein 2 10 20 45 lipide 98 90 80 55 triglyceride 88 55 8 10 phospholipid 6 20 24 22 cholesterol total 4 15 48 23 free 1 5 8 6 ester 3 10 40 17 lipide/protein 40~50 9 4 1~1.5
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Mechanisms of Hyperlipidemia Increased hepatic synthesis of LDL, VLDL and lipoprotein (a) in response to hypoalbuminemia Urinary loss of HDL Enzymatic changes with abnormal lipid biosythesis and degradation
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Edema Lower colloid osmotic pressure? 15mmHg H 2 O colloid osmotic pressure 26 mmHg Edema
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Edema Water and sodium retention? Does it related with renin-angiotensin- aldosterone system?
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How many pathological types causes nephrotic syndrome?
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Glomerular diseases that cause NS–-- Minimal Change Glomerulopathy Epidemiology: It is most common reason of NS in children, accounting for 80-90% of young patients with nephrotic syndrome , while only 20-25% in adults. There appears to be a male preponderance, especially in children, in whom the male- to- female ratio is 2~3 :1
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Minimal Change Glomerulopathy Pathology No glomerular lesions by light microscopy No staining with antisera specific for immunoglobulins or complement components. Effacement of visceral
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20090407223831_876801491057 - Nephrotic Syndrome(NS Qiang...

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