Nephrotic syndrome refers to a group of syndromes characterized by large amounts of proteinuria (>3.5/24 hours), low plasma albumin (<30g/l), hyperlipidemia, and edema. A large number of proteinuria and hypoproteinemia are necessary for diagnosis and may also be accompanied by hematuria and / or hypertension and / or persistent renal impairment. Nephrotic syndrome is caused by a variety of glomerular diseases and is pided into two major groups, primary and secondary. Therefore, it is necessary to exclude secondary nephrotic syndrome (secondary to lupus nephritis, diabetic nephropathy and Henoch Schonlein purpura nephritis) secondary to all other diseases of the body, which can be diagnosed as primary nephrotic syndrome.
In fact, there are a lot of disease etiology, onset, detailed consultation prior to the onset of no contact allergens (such as immunization, serum preparation, medicine, milk, Bacillus subtilis, pollen and so on); there is no upper respiratory tract infection, bacterial infection (especially hemolytic streptococcus, Streptococcus pneumoniae, Staphylococcus aureus infections and typhoid fever leprosy, etc.); there is no virus infection (such as varicella, mumps, rubella, infectious mononucleosis, hepatitis B, etc.); there is no history of syphilis, three malaria and falciparum malaria and schistosomiasis; there is no acute and chronic glomerulonephritis, systemic lupus erythematosus, diabetes, heart failure, liver cirrhosis and mercury, lead poisoning in history. Young and middle-aged patients should be searched for Hodgkin's disease, elderly patients should be searched for multiple myeloma and solid tumors of various organs and other diseases; are there any patients in the family?. To help identify possible causes and exclude secondary nephrotic syndrome.
Nephrotic syndrome is a group of clinically similar syndromes that is not an independent disease. The main clinical manifestations included massive proteinuria, hypoproteinemia, edema and hyperlipidemia. There are many causes of nephrotic syndrome. Generalizations can be pided into two broad categories. Primary and secondary. Primary and secondary nephrotic syndrome, although there are common clinical manifestations, but in etiology, pathogenesis and treatment are very different. Therefore, the two must be further differential diagnosis.
Primary nephrotic syndrome: minimal change nephropathy, more common in children and adolescents. Occult onset, gross hematuria. Membranous nephropathy usually occurs at 35 years of age. It is characterized by insidious onset, slow development of the lesion, easy occurrence of renal vein thrombosis, and gross hematuria. Mesangial proliferative nephropathy, frequently occurring before 30 years of age, has an acute onset. Almost all patients have microscopic hematuria, progressive renal failure, and about 1/3 of patients with hypertension. Mesangial proliferative nephritis, which occurs in young people and has an insidious onset, can also be an acute attack, accompanied by hematuria, characterized by microscopic hematuria, and mild and moderate hypertension. Focal segmental glomerulosclerosis is more common in young people, most of whom are occult, and the most common is nephrotic syndrome, followed by microscopic hematuria and progressive deterioration of renal function.
Secondary nephrotic syndrome: systemic lupus erythematosus nephropathy is common in young women and is often manifested by multiple organ damage such as joint pain, fever, facial butterfly erythema, liver and cardiovascular diseases, etc.. Blood can be found in lupus erythematosus cells, plasma globulin significantly increased. Diabetic nephropathy occurs frequently in patients with a longer history of diabetes, and diabetic retinopathy is often paralleled with renal damage. Renal amyloidosis occurs mainly in men and women above middle age and often has chronic or chronic purulent disease. Purpura nephritis is more common in adolescents, and the incidence of respiratory infection is related to the winter can be seen more, hematuria is allergic purpura, kidney and kidney damage is the most common clinical manifestations.