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Diagnosis of nephrotic syndrome

Dec 31, 2016
(a) clinical manifestation
The age of onset of different clinical types were different, and the incidence rate was the highest in preschool children. Onset can be slow, before the disease can have a history of viral and bacterial infections, a variety of infections can cause recurrence of kidney disease. Edema is the most common clinical manifestations of kidney disease, more systemic, the first is the eyelids, face in the morning is heavy, gradually spread to the body, edema of lower limbs for depression, edema and change along with the posture, can have severe ascites, pleural effusion, pericardial effusion. The boy can see scrotum, penis edema. Less urine, nephritis and kidney disease in children with hematuria and hypertension. May also be pale, listlessness, lack of appetite, diarrhea and abdominal pain.
(two) laboratory tests
1 routine urine protein qualitative: = + + +, 24 hour urinary protein quantity is more than 50mg/kg, is the main basis for the diagnosis. Because of the 24 hour urinary retention in children, especially in infants and young children, it is suggested that the urine protein / urine creatinine ratio be used instead of the determination of urinary protein in 24 hours. This method is simple, take any urine in the morning for the first time, the determination of urine protein and urine creatinine, urine protein / urine creatinine was 3.5 for nephrotic range proteinuria. The red blood cells, and the tubular type. 2 plasma protein: plasma total protein was lower than normal, albumin decreased significantly, <2.5~3g/dl, albumin / globulin ratio inversion, alpha globulin increased 2, gamma globulin decreased.
3 increased serum cholesterol. Esr. 4 renal function: generally normal, but a small amount of urine when there is a temporary hypoxemia. 5 serum complement: nephritis nephropathy reduced complement.
(three) differential diagnosis
1 acute nephritis: part of acute nephritis showed a large number of proteinuria, urine protein should be monitored, if necessary, to make a clear diagnosis of renal puncture, guide treatment.
2 IgA nephropathy: a large number of proteinuria or proteinuria and hematuria as the main clinical manifestations of IgA nephropathy need to be identified by renal puncture.
3 lupus nephritis: a large number of children with unknown causes of onset of proteinuria should be diagnosed with lupus serology diagnosis.
4 cases of Henoch Schonlein purpura nephritis: a history of skin rash.
5 hepatitis B virus infection associated nephritis: a large number of proteinuria as the main performance of children with hepatitis B should be the six examination, hepatitis B surface antigen positive should be a clear diagnosis of renal biopsy.
6 chronic nephritis: according to the history, clinical manifestations, laboratory tests and renal function evaluation can be a clear diagnosis.

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