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Nephrotic syndrome is a disease of different life with the d

Dec 28, 2016
Department of Nephrology, experts said, nephrotic syndrome is a disease of different life with the disease, nephrotic syndrome, some patients are easily cured, and no recurrence, but this is seldom. Nephrotic syndrome can be cured, depends on many factors, one is the type of disease itself, two is the child and parents of the degree of cooperation with the treatment. Nephrotic syndrome is not a single disease, it is a kind of disease, the pathological diagnosis was "minimal change" with the best prognosis, the prognosis for focal segmental glomerulosclerosis and membranoproliferative glomerulonephritis "worst. Children with small lesions of 90%-95% are effective for the first time using hormone therapy, but 85% of them will relapse. More common in the first year than after. That is to say, most nephrotic syndrome children in the onset of 1-2 years will experience recurrence, but some frequent, some not frequent, as well as hormone dependence or resistance, that is, resistance. If a child 3-4 years without recurrence, then there will be 95% chance of recurrence. Minimal changes to uremia are rare, most of whom die from severe side effects of infection or hormones or immunosuppressants. Nephrotic syndrome is a chronic disease, if children and parents do not pay attention to accept the scientific treatment standard, excessive fear of side effects of hormone, superstitious remedies, Chinese herbal medicine and recipe, do not comply with the doctor's advice to take medicine, referral, do not pay attention to proper diet and daily life care, is more easy to relapse, more difficult cure! In patients with nephrotic syndrome edema stage, bed rest, bed can increase renal blood flow, to diuretic swelling, and reduce the contact with the outside world, to prevent cross infection, but in the period of bed rest, can still maintain a proper bed, to prevent limb vascular thrombosis. After remission, gradually increased activity. If the patient is a student, should be suspended for a period of time (e.g. 3 -6 months), after disease remission, then return to school, the best one year not to participate in physical exercise. This disease should be easy to digest, low fat, rich calorie diet, edema limit salt, avoid eating pickled food, pickles, etc.. Food protein amount, can be given per kilogram of body weight per day, not high protein (above) diet, because it will increase the burden on the kidneys. Nephrotic syndrome has 4 main features, namely, proteinuria, hypoproteinemia, hypercholesterolemia, and systemic edema. 1 massive proteinuria: massive proteinuria is a sign of nephrotic syndrome. The main component is albumin, also contains other plasma protein components. Changes in the permeability of the glomerular basement membrane is a primary cause of proteinuria and charge barrier and mechanical barrier (glomerular capillary pore barrier) changes also affect the renal tubular epithelial cell uptake and catabolism ability on the formation of proteinuria. Glomerular filtration rate, plasma protein concentration and protein intake directly affect the degree of proteinuria. Reduced glomerular filtration rate, proteinuria will reduce; severe hypoproteinemia, urinary protein excretion increased, high protein diet will increase the excretion of urinary protein; therefore, only the method of quantitative protein every day, can not accurately judge the degree of proteinuria, but further albumin clearance rate, urinary protein / creatinine (>3.5 often nephrotic range proteinuria). Urine protein electrophoresis detected increased urinary IgG composition suggesting low urinary protein selectivity. Urine protein selectivity has no positive clinical value and is now used less. 2 hypoproteinemia: nephrotic syndrome must be the second characteristics. Serum albumin was lower than 30g/L. Nephrotic syndrome increased synthesis of albumin in liver syndrome, when given enough protein and calories in the diet, the liver synthesis of albumin in patients with about 22.6g per day, significantly increased than normal 15.6g every day. When the compensatory effect of liver albumin is insufficient to compensate for the loss of urinary protein, hypoproteinemia will occur. There was no consistent agreement between hypoproteinemia and urinary protein output. 1), patients with nephrotic syndrome is usually negative nitrogen balance, high protein load, can be transformed into positive nitrogen balance, high protein load may make urine protein increased due to the increase of glomerular filtration protein, the plasma protein did not increase significantly, but at the same time taking blood angiotensin converting enzyme inhibitor, can inhibit urinary protein excretion, serum albumin concentration increased significantly. 2, it is worth noting that, when hypoproteinemia, the combination of drugs and albumin will be reduced, elevated blood free drug concentration, may increase the toxicity of drugs. 3, nephrotic syndrome when a variety of plasma protein components can change, alpha 2 and beta globulin increased, alpha globulin more normal 1. The level of IgG was significantly decreased, while IgA, IgM and IgE levels in normal or increased, fibrinogen and coagulation factor V, VII and VIII, X can be increased, and increased hepatic synthesis may, with the increase in the number of platelets, antithrombin III (heparin related factor) decreased, C protein and S protein concentration than normal or increased, but the activity decreased. This will contribute to the occurrence of hypercoagulable state. The increase of fibrin degradation product (FDP) in urine reflects the change of glomerular permeability. In conclusion, various pre - factors of coagulation and agglutination were increased, but the mechanism of anti coagulation and fibrinolysis was impaired. Due to the combined effects of hypercholesterolemia and fibrinogen, the plasma viscosity increases, and spontaneous thrombosis occurs when vascular endothelium is damaged. 4), in addition, transporter is also reduced, such as carrying important metal ions (Cu, Fe, Zn) protein decreased, and the most important hormones (thyroxine, cortisol, prostaglandins) and active 25- (OH) D3 binding protein also decreased, which may result in secondary parathyroidism. The metabolism of calcium and phosphorus, lead to renal osteodystrophy. The continuous decrease of transferrin causes the glucocorticoid to change the free and bound hormone ratio in the treated patients, leading to the change of metabolism and efficacy. 3 hyperlipidemia, the total cholesterol, three acyl glycerol significantly increased, low density lipoprotein (LDH), very low density lipoprotein (VLDH) levels increased. Hyperlipidemia is associated with hypoalbuminemia, LDL/HLDL is only increased when serum albumin is below 10 ~ 20g/L. High density lipoprotein (HDL) normal or decreased. Elevated LDL/HDL ratio increases the risk of arteriosclerotic complications, and hyperlipidemia is associated with thrombosis and progressive glomerulosclerosis. The patients showed urinary lipid, fatty body double refraction in urine, possibly for epithelial cells or fat body tube containing cholesterol

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