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What is the differential diagnosis of nephrotic syndrome

Dec 26, 2016
Nephrotic syndrome is a group of relatively stubborn disease, clinical treatment is very difficult, the most basic characteristic is often accompanied by proteinuria, hypoalbuminemia, edema and hyperlipidemia, clinical called "three high and one low" symptoms. According to the etiology of the disease can be pided into two categories of primary and secondary, primary nephrotic syndrome is the most common clinical manifestations of primary glomerular disease, and secondary nephrotic syndrome more reasons.
1, primary nephrotic syndrome
For primary glomerular disease, such as minimal change nephropathy, membranous nephropathy, membranous proliferative nephropathy, mesangial proliferative glomerulonephritis, focal segmental glomerulosclerosis, etc..
(1) minimal change nephropathy, more common in children and adolescents. Occult onset, gross hematuria.
(2) membranous nephropathy, generally occurring at the age of 35 years, the onset of occult, slow development of lesions, prone to renal vein thrombosis, rare hematuria.
(3) membrane proliferative nephropathy, frequently occurring before the age of 30, onset of acute, almost all patients have microscopic hematuria, renal function showed progressive decline, about 1/3 patients with hypertension.
(4) mesangial proliferative nephritis, predilection in young people, hidden onset, but also acute attacks, accompanied by hematuria, mainly microscopic hematuria, and mild to moderate hypertension.
(5) focal segmental glomerulosclerosis, more common in young people, almost all patients are occult disease, the most manifestations of nephrotic syndrome, followed by microscopic hematuria, progressive renal dysfunction.
2, secondary nephrotic syndrome
There are many causes of secondary nephrotic syndrome, such as systemic diseases, metabolic diseases, allergic diseases, infectious diseases, renal toxicity, cancer, genetic diseases, chronic renal allograft rejection and toxemia of pregnancy. But there are only a few clinical common, such as systemic lupus erythematosus kidney, diabetic nephropathy, renal amyloidosis, Henoch Schonlein purpura nephritis, etc..
(1) systemic lupus erythematosus nephropathy is common in young women, often manifested as multiple organ damage, such as joint pain, fever, facial sphenoid erythema, liver and cardiovascular system lesions. Lupus erythematosus cells can be found in blood, plasma globulin significantly increased.
(2) diabetic nephropathy patients with a long history of diabetes mellitus, diabetic retinopathy, often parallel to kidney damage.
(3) renal amyloidosis mainly occurred in middle-aged men and women, often with chronic inflammation or chronic suppurative lesions.
(4) Henoch Schonlein purpura nephritis occurs mostly in young people, morbidity and respiratory infection, winter can be seen, hematuria is allergic purpura kidney kidney damage the most common clinical manifestations.
Reminder: complete diagnosis of nephrotic syndrome syndrome should first confirm the diagnosis of nephrotic syndrome, and then confirm the cause, exclusion of secondary causes and genetic etiology, diagnosis of primary nephrotic syndrome patients, no contraindication to renal biopsy pathological diagnosis to determine the best to do, finally to judge the patients had no other complications. Especially with infection, thrombosis and acute renal failure, should be timely to judge, to give the corresponding treatment.

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