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Pathological types of primary nephrotic syndrome

Dec 31, 2016
1 minute lesion (MCD)
Good hair in young children, especially 2~6 years old children, but there is a peak age. More male than female. The disease has a rapid onset, rapid emergence of a large number of proteinuria, and nearly 100% cases of nephrotic syndrome. The incidence of hematuria under microscope was low (15%~20%), and there was no gross hematuria, no persistent hypertension and renal function damage (severe edema could be transient hypertension and hyperlipidemia, and then dissipated after diuresis).
2 mesangial proliferative glomerulonephritis (MsPGN)
Good hair in young people, more men than women. There are pre infection (50%), the incidence of acute, can be presented with acute nephritis syndrome (about 20%~ of the total number of patients), otherwise often attack attack onset. Nephrotic syndrome incidence of non IgA nephropathy IgA nephropathy (about 30% higher than the former, the latter is about 15%), while the incidence of hematuria in IgA nephropathy than non IgA nephropathy (the former almost 100%, which is about 70%; the occurrence rate of gross hematuria is about 60%, which is about 30%). Renal dysfunction and hypertension increased gradually with the severity of renal disease. This type of nephritis is very high in China, accounting for about half of the primary glomerular disease, IgA nephropathy and non IgA nephropathy is about 1/2, 1/3 cases of primary nephrotic syndrome in our country caused by this type of nephritis.
3 mesangial capillary nephritis (MCGN)
Membrane proliferative glomerulonephritis. Good hair in young adults, male more than female. There are prodromal infections (about 60%~70%), the incidence of acute, can be presented with acute nephritis syndrome (about 20%~30%), otherwise also attack attack. Often presented with nephrotic syndrome (accounting for 60%), accompanied by significant hematuria (almost 100% of hematuria, gross hematuria of 20%), the disease continues to progress, renal dysfunction, hypertension and anemia appear early. About 50%~70% serum complement C3 continued to decline, the diagnostic significance of this disease.
4 membranous nephropathy (MN)
Good hair in the elderly, male than female. Insidious onset, high incidence of nephrotic syndrome (80%), some cases had microscopic hematuria (about 40%), but no gross hematuria. Disease progression is slow, usually in the onset of 5~10 years after the onset of renal dysfunction and hypertension. However, it is very easy to cause complications of thrombosis. The incidence of renal vein thrombosis is reported to be as high as 30%~60%.
5 focal segmental glomerulosclerosis (FSGS)
Good hair in young people, more men than women. Insidious onset, the incidence of nephrotic syndrome (50%~75%), the incidence of hematuria is very high (about 75%), visible gross hematuria (about 20%). The diagnosis of kidney dysfunction and hypertension. In addition, the renal tubular dysfunction, such as renal diabetes, often occurs.
The glomerular disease has the following features: a pathological type can present a variety of clinical manifestations, and clinical manifestations can be derived from a variety of pathological types, between the two there is a wide range of cross links, so could not completely correct inference. In general, the highest accuracy of the clinician to infer the type of pathology based on clinical presentation is only 60%~70%. Therefore, in order to make accurate diagnosis of primary nephrotic syndrome, renal biopsy must be performed.

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