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nephrotic syndrome

Dec 31, 2016
Nephrotic syndrome (nephrotic syndrome, referred to as NS) is caused by many factors in kidney disease, glomerular basement membrane permeability, and thus a large number of plasma protein in the urine loss caused by a clinical syndrome, has four major characteristics: the proteinuria; hypoproteinemia; high cholesterol; different degrees of edema. According to the etiology can be pided into three categories: primary, secondary and congenital. Primary nephrotic syndrome is unknown, according to its clinical manifestations, it is pided into two types: simple and nephritic type. Secondary nephropathy refers to the presence of renal disease on the basis of a definite diagnosis. Congenital kidney disease is autosomal recessive genetic disease, more than 3 months after the onset of neonatal or postnatal onset, severe illness, causing death. The majority of children during the period of primary nephropathy, so the focus of the introduction of primary nephropathy.
The etiology and pathogenesis is not very clear. The incidence of simple nephropathy may be related to the cellular immune dysfunction, and the changes of immunoglobulin and complement components can be found in the nephrotic syndrome. Congenital kidney disease related to heredity.
"Pathophysiological" because of glomerular filtration membrane permeability, protein swim increased, the formation of a large number of proteinuria. The change of glomerular filtration membrane permeability is related to the change of the surface charge of glomerular epithelial cell in addition to pathological changes. Normal membrane sialic acid protein, albumin and negatively charged molecules in PH7.4 with negative charge, because of same-sex repulsion, is not easy to make albumin filtration, simple nephrotic syndrome when sialic acid protein decreased. Increased protein filtration.
Lead to proteinuria hypoproteinemia, especially albumin decreased, the plasma colloid osmotic pressure decreased, water and electrolyte by blood vessels infiltration into tissue, and secondary aldosterone secretion, increased secretion of antidiuretic hormone. The reduction of sodium and other factors, further aggravated edema. The main reason for the occurrence of hypercholesterolemia is due to the increase of compensatory synthesis in liver, followed by the decrease of lipoprotein catabolism. This disease has a variety of pathological types, among which the most common form of micro disease (about 80%); simple nephropathy mainly belong to this type, followed by focal segmental glomerulosclerosis and membranous proliferative glomerulonephritis. A small number of mesangial proliferative or membranous nephropathy, such lesions are more likely to be nephritic nephritis.
Clinical manifestation
1 the incidence of simple renal disease is mostly from 2 to 7 years old. The ratio of male to female was 2:1
(1) the whole body can be concave edema, face, lower limbs, scrotum is obvious, often ascites, general body condition is still good, no hypertension.
(2) oliguria, urinary protein is from ~, quantitative > 0.1g/ (kg.d). I have a small amount of red blood cells in urine microscopy.
(3) the total plasma protein below normal albumin was significantly lower (< 30g / L), serum protein electrophoresis showed a reduction in the proportion of albumin, and? Globulin ratio increased, R globulin decreased. Blood cholesterol was significantly higher (5 7mmol / L), serum complement was normal.
(4) the renal function was normal, and there was a slight mild hypoxemia during the period of edema.
2 the incidence of nephritis nephropathy in school-age children, the clinical features are as follows:
(L) age of onset is more common in children over 7 years of age, edema is generally not serious.
(2) blood pressure can be increased in varying degrees, often with paroxysmal or persistent hypertension and hematuria.
(3) serum complement can be reduced, and there are different levels of nitrogen.
3 congenital kidney disease is rare, mostly recessive genetic disease, more common in the neonatal period and the onset of the disease within three months after birth, the performance is similar to simple kidney disease.
4 complication
(1) infection: upper respiratory tract infection, skin infection, peritonitis, etc..
(2) electrolyte disorder: low sodium and low potassium and calcium.
(3) thrombosis: arterial and venous thrombosis of renal vein thrombosis in common clinical lumbar abdominal pain, hematuria.
Treatment principles
L. hormone therapy
The commonly used prednisone, according to the type of disease, children of prednisone reaction, were used in 8 weeks of treatment, short course 4-6 months and 9 ~ 12 month long course. Short course of treatment for the initial treatment of simple kidney disease, medium and long course of treatment for multiple renal disease, relapsing or simple nephrotic syndrome.
Effect of judgment: hormone sensitive: urine protein negative 8 weeks after hormone treatment, edema. Part II: hormone sensitive treatment within 8 weeks of edema, but urinary protein is still ten to twenty, with 8 weeks of the treatment of steroid resistant, proteinuria was more than twenty; the hormone dependence: the urine protein was negative after hormone therapy, but the withdrawal or reduction appears after the "+" above, re treatment or recovery the amount of urinary protein was negative for two times (with the exception of infection and other factors). The above changes in urine were distributed in 7 to 10 days, the results of the 3 urine routine examination.
2 immunosuppressive agents
Cases of hormone therapy is ineffective or much side effects can be combined with immunosuppressive therapy, commonly used with vincristine, Wilfordine, cyclophosphamide, sulfur bird at full mycomycin A Yin; ring etc..
3 diuretics
Generally sensitive to hormone therapy, medication 7 to 10 days after the emergence of diuretic, do not use diuretics. Severe edema may use diuretics, furosemide (Lasix) is usually used for intravenous administration, the best first infusion of low molecular dextran, often can produce a good diuretic effect.
Common nursing diagnosis
1 excessive body fluid and sodium retention caused by hypoproteinemia.
2 malnutrition, lower than the body needs and a large number of proteins related to loss of urine.
3 there is a risk of impaired skin integrity associated with a high degree of edema.
4 the risk of infection is associated with low immunity.
5 potential complications, drug side effects and long-term use of corticosteroids and immunosuppressive agents.
6 anxiety and disease recurrence and long course of disease.
"Nursing measures"
1 severe edema and high blood pressure need to stay in bed, generally do not need to strictly limit the activities, according to the appropriate arrangements for recreational activities, so that children with mental pleasure.
2 diet to ensure heat, protein intake control at around 2G / kg is appropriate. Clear edema or high blood pressure when short-term salt limit
3 skin care to keep the skin clean and dry, to avoid abrasions and pressure, turn over time. Bedding should be soft. The buttocks and limbs can be padded with rubber air cushion or cotton ring. Edema of the scrotum with a cotton pad or sling up, skin rupture should be covered with a sterile dressing to prevent infection. 4 severe edema should avoid intramuscular injection of drugs due to severe edema often caused by drug retention, or malabsorption after injection pinhole extravasation leading to local, moisture, erosion or infection. We must pay attention to intramuscular injection, strict disinfection, injection after pressing slightly longer, to prevent extravasation.
5 to observe the changes of 24 hours and the amount of edema, abdominal circumference and body weight were recorded daily and weekly urine routine 2 ~ 3 times.
6 children with infectious diseases and infectious diseases in children room. To avoid the cold, do not go to crowded places.
7 to observe the efficacy and side effects of drugs
(1) prednisone application process in strict accordance with the prescribed medicine, ensure medication, to prevent hidden, leading to the effect of error of judgment. Pay attention to the side effects of hormones, such as Cushing's syndrome, hypertension, peptic ulcer, osteoporosis, etc..
(2) the amount of urine should be observed during the application of diuretics, excessive amount of urine contact with the doctor, reduction or discontinuation, to prevent electrolyte disorders.
(3) the use of immunosuppressive agents, such as cyclic adenosine monophosphate, is associated with a decrease in the number of white blood cells, hair loss, gastrointestinal reactions, and hemorrhagic cystitis. During the course of medication to the water and regular blood test, the course is not more than 12 weeks, in order to avoid gonad damage.
8 health education on the importance of hormone therapy for this disease, so that children and parents actively cooperate with and adhere to the medication plan; disease hospitalization time is long, the rest of time should be planned, after disease remission, appropriate arrangements for certain learning; the Caution!, avoid running between children, slapstick, in case falls and fractures; the children and their parents know that infection is the most common cause of complications and recurrence of the disease, so take effective measures to prevent infection by the church is crucial; parents or older children learn to use the changes of urinary protein test monitoring.

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