肾病综合症临床诊断思维程序（Nephrotic syndrome, clinical diagnosis, thinking procedure）.docVIP

肾病综合症临床诊断思维程序（Nephrotic syndrome, clinical diagnosis, thinking procedure） Nephrotic syndrome is not a disease, but a syndrome including lupus nephritis, diabetic nephropathy, tumor and many secondary diseases, if the secondary nephrotic syndrome misdiagnosed as primary nephrotic syndrome, will delay the illness. The primary nephrotic syndrome has different pathological types, and its treatment, efficacy and prognosis are different. Therefore, no understanding of the pathological type and complications of nephrotic syndrome will undoubtedly affect the clinical efficacy. This article is divided into five steps, and gradually introduces the clinical thinking of the diagnosis of nephrotic syndrome. Step 1: is it nephrotic syndrome? 1. massive proteinuria Proteinuria is the most important index in the diagnosis of nephrotic syndrome. The so-called large amount of proteinuria, refers to the daily urine protein is greater than 3.5g. But a 5-6 year old child and a tall adult, 3.5G proteinuria is not a concept. Therefore, the body surface area should be calculated. The average surface area of Chinese is 1.73M2. Therefore, a large number of proteinuria, in addition to the daily requirements of 3.5G, but also with the 1.73M2 surface area to limit. 2. hypoproteinemia Large amounts of albumin are lost from urine, and some albumin is broken down from epithelial cells of the proximal convoluted tubule, and the liver is unable to compensate for loss of protein by breaking down and breaking down. Hypoproteinemia mainly refers to plasma albumin or 30g/L. Besides the reduction of plasma albumin, plasma in some immune globulin, complement, anticoagulant and fibrinolytic factors is also reduced, prone to infection, hypercoagulable, micronutrient deficiencies, endocrine disorders and immune dysfunction and other complications. 3. hyperlipidemia A lot of urinary protein, plasma protein decreased, protein synthesis of liver compensatory increase of small proteins or lost in the urine, bec