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Nephrotic syndrome can be easily confused with any disease

Diagnosis of primary nephrotic syndrome must first be identified with secondary nephrotic syndrome. There are several types of secondary nephrotic syndrome that are common in clinical and must be identified by the disease. Purpura nephritis...

Nephrotic syndrome can be easily confused with any disease

May 16, 2017 by Kidney Disease Expert

Diagnosis of primary nephrotic syndrome must first be identified with secondary nephrotic syndrome.
There are several types of secondary nephrotic syndrome that are common in clinical and must be identified by the disease.
Purpura nephritis;
The patient has the characteristic such as rash, purpura, joint pain, abdominal pain, and blood and blood, and also has the characteristics of hematuria, proteinuria, edema, high blood pressure and other nephritis.
If the characteristic of purpura is atypical, it is easily misdiagnosed as primary nephrotic syndrome.
Serum IgA is often elevated in the early stages of the disease.
Renal biopsies are common pathological changes in the membrane hyperplasia, and immunopathology is the main sediment of IgA and C3, so it is not difficult to identify.
Lupus nephritis;
See more at 20 ~ 40 years old women, patients with fever, rash and arthritis pain, serum antinuclear antibodies, antibody positive ds - DNA resistance, resistance to SM, C3, renal biopsy then in addition to the mesangial proliferation, lesions have persity characteristics.
Immunopathology is "full of light".
Diabetic nephropathy;
Patients with more than 10 years of diabetes can be treated with nephrotic syndrome.
Intraocular examination has microvascular changes.
The renal biopsy showed the thickening of the basal membrane of the glomerulus and the hyperplasia of the mesostroma, typically the formation of the kimmelstiel-wilson nodules.
Renal biopsy can be clearly diagnosed.
Hepatitis b virus related nephritis;
Can be expressed as nephrotic syndrome, the virus serum check to confirm the disease of the disease, the nephropathy of the kidney to detect the hepatitis b virus antigen composition.
The Wegner granuloma;
Nasal and sinus necrotic inflammation, pneumonia and necrotic glomerulus are the three major characteristics of the disease.
The clinical features of renal lesion are acute glomerulonephritis or nephrotic syndrome.
Serum gamma globulin, IgG, IgA rise.
Amyloidosis;
Early can only proteinuria, generally after 3 ~ 5 years of nephrotic syndrome, higher serum levels of gamma globulin, heart, liver, spleen, skin serum gamma globulin lichen myxoid edema, diagnosis depends on renal biopsy.
Nephrotic syndrome caused by malignant tumors;
All kinds of malignancies can cause nephrotic syndrome by the immune mechanism, and even the early clinical manifestations of nephrotic syndrome.
Therefore, patients with nephrotic syndrome should be extensively examined to eliminate malignant tumors.
Kidney transplantation after transplantation of kidney transplantation;
Recurrence of nephrotic syndrome after kidney transplantation is about 10%, 1 week to 25 months postoperatively, usually appear proteinuria, patients often severe nephrotic syndrome, and loss of graft in 6 months to 10 years.
Drug induced nephrotic syndrome;
Organic gold, mercury, D - penicillamine, captopril (captopril), non-steroidal anti-inflammatory drugs can cause nephrotic syndrome (such as membranous nephropathy).
Should pay attention to the history of medicine, stop medicine in a timely manner may make the disease remission.
Human immunodeficiency virus associated with kidney disease;
The human immunodeficiency virus (hiv-an) is AN AIDS patient's kidney disease, often in the early stages of HIV infection, before other serious infections.
According to the patients with and without HIV risk factors (such as intravenous drug abuse, gay, areas prone to HIV and the crowd), early HIV testing and HIV antibody detection, and combined with other clinical manifestation of HIV (such as asymptomatic infection, persistent lymph node enlargement, secondary tumor) can contribute to the diagnosis of HIV - the AN.
Combined with the range of proteinuria and nephrotic syndrome patients with nephrotic syndrome patients, especially for the short term progressive deterioration of renal function focal segmental glomerular sclerosis patients should think of the possibility of this disease.
The nephrology of hiv-an is characterized by the contraction and collapse of the capillaries in a global or segmental glomerulus, accompanied by significant hyperplasia.
If any of the glomeruli of the glomerulus is in the form of a global collapse or more than 20% of the glomeruli, the disease should be considered.
There is a large network of network inclusions (80 to 90 percent of hiv-an patients) in the endothelial cells and interleukocyte cells of HIV under the electron microscopy, which helps to establish the diagnosis.
Mixed connective tissue disease and kidney damage;
Patients with systemic sclerosis and systemic lupus erythematosus (sle) and multiple myositis or a combination of dermatomyositis three diseases, but can not be confirmed one of the diseases, high serum can be detected more drops of RNP antibody resistant, anti SM antibody negative, serum complement almost normal.
Renal damage is only about 5%, mainly for proteinuria and hematuria, can also occur nephrotic syndrome and normal renal function, renal biopsy pathology change of mesangial proliferative glomerulonephritis or membranous nephropathy.
The response to glucocorticoid was good and the prognosis was good.
Kidney damage of rheumatoid arthritis;
Rheumatoid arthritis in 20 ~ 50 years old women, the incidence of renal damage is low, the cause of renal damage may have the following several ways: rheumatoid arthritis, rheumatoid arthritis and analgesic nephropathy renal amyloidosis, rheumatoid arthritis complicated with glomerulonephritis.
Concurrent nephrotic syndrome rheumatoid arthritis is rare, and its positive rheumatoid factor, renal biopsy for membranous glomerulonephritis, the most common application of corticosteroids can be improved after treatment.
The renal lesion of cryoglobulinemia;
Clinical encounter purpura, joint pain, Renault phenomenon, hepatosplenomegaly, swollen lymph nodes, visual impairment, and cerebral thrombosis, vascular syncope concurrent glomerulonephritis, consideration should be given to the disease, further confirmed that blood cold globulin heighten, can determine the diagnosis.
Cryoglobulinemia can cause kidney damage.
Chronic glomerular disease occurs in one in three patients with chronic glomerular disease, which is characterized by proteinuria and endoscopic hematuria, often with nephrotic syndrome and high blood pressure, and the prognosis is poor.
A few patients are characterized by acute nephritis syndrome, which can be developed into acute nephritis syndrome, which develops directly to end-stage failure.
Renal lesions of tuberous disease;
Sarcoidosis is rare multisystem granulomatous disease of unknown etiology, kidney involvement is relatively rare, clinical renal damage accounted for about 1%, renal biopsy and autopsy, it found that 20% complicated with nephropathy, multiple in 30 ~ 50 years old, male or female.
Diagnosis relies mainly on the laboratory tests and chest photos, lymph nodes, skin, liver, kidney biopsy, elevated serum angiotensin converting enzyme activity such as help the diagnosis.
The renal lesion of sarcoidosis can be pided into: the granuloma is a direct invasion of the kidney, the calcium metabolism abnormal causes kidney damage and glomerulonephritis.
Cellulosic glomerular disease;
Men see more, 40 ~ 60 years old, most patients with microscopic haematuria, almost all of the patients had proteinuria, 60% ~ 70% of patients of nephrotic syndrome category proteinuria, more than 50% of the patients with high blood pressure, the vast majority of no systemic disease, have a few cases with malignant tumor.
Under electron microscopy shown similar amyloid fibre material or are hollow tubes of the structure of the fiber material, but for Congo red dyeing and sulfur element T negative.
At the moment, they tend to think of both as the same disease.
Collagen Ⅲ glomerular disease;
Both adults and children can develop the disease, men see more.
Autosomal recessive, often deal with the characteristics of proteinuria and nephrotic syndrome, kidney function is normal, for a long time to progression to chronic renal failure gradually, after renal biopsy pathologic examination is the only means of diagnosis of the disease, immunofluorescence visible broadening of mesangial area and the capillaries were seen strong positive collagen Ⅲ.
Fiber-linked glomerular disease;
The onset of the disease is between 14 and 59 years of age, especially in young people under 30 years of age, both men and women can be affected, the disease is autosomal dominant inheritance.
Proteinuria is a common clinical manifestation of the disease, with 50% of patients having high blood pressure.
Renal biopsy pathologic examination in the mesangial area by optical microscopy and subcutaneous homogeneous transparent material (PAS positive), when stained with Congo red and negative electron microscopy visible capillary loop cavity filled with fine granular electron dense, basement membrane thickness is normal, the fiber diameter of Congo red stain feminine relatively immune fiber tubular disease is small, its distribution and optical microscope can see consistent PAS positive substance;
The immunopathologic examination was a positive result of the fibrous glomeruli, which is strongly positive and diffused in the mesodermal area and hypodermic, which helps to confirm the diagnosis.
Lipoprotein kidney disease;
The majority of men, most of them are sporadic, and a few are familial.
All of the patients have proteinuria, some of which are progressing to proteinuria in the area of nephropathy, and lipoprotein is not embolised outside the kidney.
Its pathological features for the expansion of the highly exist in the glomerular capillary loop cavity layer change "lipoprotein embolus", histochemical staining of lipoprotein positive, electron microscope to confirm the lipoprotein embolism, and exist lipid metabolic abnormalities, diagnosis is not difficult to establish.
There is no cure for the disease.

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