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Department of pediatrics The first affiliated hospital Sun Yat Sen University Sun Liangzhong ( 孙良忠 ) [email_address] Nephrotic Syndrome
Definition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification ,[object Object],[object Object],[object Object],[object Object]
Idiopathic Nephrotic Syndrome ,[object Object],[object Object],[object Object],[object Object]
a Basement membrane b Epithelial cell c Endothelial cell d Mesangial cell Glomerular filtration barrier
Glomerular filtration barrier a Basement membrane b Epithelial cell c Endothelial cell d Mesangial cell
Glomerular filtration barrier ,[object Object],[object Object]
aperture barrier Endothelium slit diaphragm
 
Charge-selective barrier Endothelium
 
 
Nonselective proteinuria
[object Object],[object Object],[object Object],[object Object],[object Object],Pathological changes in INS
 
 
 
Mild Moderate Mesangial proliferative glomerulonephritis
Focal segmental glomerulosclerosis (FSGS)
membranous nephrosis (MN)
Membranoprliferative glomerulonephritis
Pathological patterns of INS in children and adults
Pathophysiology Pathogenetic factor glomerular permeability↑ massive proteinuria Hypoproteinemia lipoproteins synthesis ↑ hyperlipidemia Plasma oncotic pressure↓ Intravascular volume ↓ RAA(aldosterone)↑ ADH↑ Water  sodium retention Edema Fluid Interstitial space Lipoprotein lipase ↓
Clinical manifestation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Laboratory tests
Diagnosis and classifications ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Simple type and Nephritic type Clinical types
Differential diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment General treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],Treatment
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],classification on curative effects
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Side effects of corticosteroid
[object Object],[object Object],[object Object],[object Object],Indications for Alternative agents
Alternative agents for INS ,[object Object],[object Object],[object Object],[object Object]
Cyclophosphamide (CTX) ,[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Side effects of CTX
Cyclosporine and tacrolimus ,[object Object],[object Object],[object Object]
Side effects of CSA and FK506 ,[object Object],[object Object],[object Object],[object Object]
Mycophenolate and ACEI ,[object Object],[object Object]
Others ,[object Object],[object Object],[object Object],[object Object]
Complications ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],E lectrolytes disorder and hypovolemia
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Acute renal failure
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prognosis ,[object Object],[object Object]
Thank You

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C:\documents and settings\administrator\桌面\20100607 nephrotic syndrome