Nephrotic Syndrome Ppt Download For Mac
Title: Nephrotic syndrome 1 Nephrotic syndrome 2 Figure 1. Nephrotic edema. Nephrotic edema.
4 Clinical Syndrome.??????????????????????????????????????????????????????,??????????????????????????????????,???????????????????? 5 The most common syndrome of kidney disease?????????.
Nephrotic syndrome. Nephritic syndrome. Asymptomatic urinary abnormalities. Acute renal failure or Rapidly progressive renal failure. Chronic kidney disease(Table 1) (?)????? (?)?????(?1) 6 Table 1.
STAGES OF CHRONIC KIDNEY DISEASE STAGE DESCRIPTION GFR (mL/min/1.73m2) 1 Kidney damage with normal or? GFR 90 2 Kidney damage with mild or? GFR 60-89 3 Moderate? GFR 30-59 4 Severe?
GFR 15-29 5 Kidney failure lt15 (or dialysis) Chronic kidney disease is defined as either kidney damage or GFR lt 60mL/min/1.73m2 for 3months. Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests or image studies. 7 Nephrotic syndrome. This is characterized by proteinuria (Typically gt 3.5g/24h),.
hypoalbuminemia ( less than 30g/dL ) and edema. Hyperlipidaemia is also present. Primary and secondary causes are summarized in Table 2, 3. In practice, many clinicians refer to nephrotic range proteinuria regardless of whether their patients have the other manifestations of the full syndrome because the latter are consequences of the proteinuria. 8 NEPHROTIC SYNDROME. Pathophysiology. Proteinuria.
Hypoalbuminemia. Edema. Hyperlipidemia. Cause (diagnosis and differential diagnosis). Systemic renal disease. hepatitis B associated glomerulonephritis, Henoch-Schonlein purpura, systemic lupus erythematosus, diatetes mellitus, amyloidosis.
Idiopathic nephrotic syndrome. Snap on flowvella example. Complications. Infection. Coagulation disorders.
Protein malnutrition and dyslipidemia. Acute renal failure 9 Pathophysiology 10 Proteinuria. Proteinuria can be caused by systemic overproduction, tubular dysfunction, or glomerular dysfunction. It is important to identify patients in whom the proteinuria is a manifestation of substantial glomerular disease as opposed to those patients who have benign transient or postural (orthostatic) proteinuria. 11 Heavy proteinuria (albuminuria) Figure 3.
12 Hypoalbuminemia. Hypoalbuminemia is in part a consequences of urinary protein loss. It is also due to the catabolism of filtered albumin by the proximal tubule as well as to redistribution of albumin within the body. This in part accounts for the inexact relationship between urinary protein loss, the level of the serum albumin, and other secondary consequences of heavy albuminuria. 13 Edema. The salt and volume retention in the NS may occur through at least two different major mechanisms.
In the classic theory, proteinuria leads to hypoalbuminemia, a low plasma oncotic pressure, and intravascular volume depletion. Subequent underperfusion of the kidney stimulates the priming of sodium-retentive hormonal systems such as the RAS axis, causing increased renal sodium and volume retention, In the peripheral capillaries with normal hydrostatic pressures and decreased oncotic pressure, the Starling forces lead to transcapillary fluid leakage and edema.
14 Edema. In some patients, however, the intravascular volume has been measured and found to be increased along with suppression of the RAS axis.
An animal model of unilateral proteinuria shows evidence of primary renal sodium retention at a distal nephron site, perhaps due to altered responsiveness to hormones such as atrial natriuretic factor. Here only the proteinuric kidney retains sodium and volume and at a time when the animal is not yet hypoalbuminemic. Thus, local factors within the kidney may account for the volume retention of the nephrotic patient as well. 16 Hyperlipidemia. Most nephrotic patients have elevated levels of total and low-density lipoprotein (LDL) cholesterol with low or normal high-density lipoprotein (HDL) cholesterol.
Lipoprotein (a) Lp(a) levels are elevated as well and return to normal with remission of the nephrotic syndrome. Nephrotic patients often have a hypercoagulable state and are predisposed to deep vein thrombophlebitis, pulmonary emboli, and renal vein thrombosis.
17 Cause 18 Table 2 CAUSES OF THE NEPHROTIC SYNDROME 19 Table 3a NEPHROTIC SYNDROME ASSOCIATED WITH SPECIFIC CAUSES (SECONDARY NEPHROTIC SYNDROME) 20 Table 3b NEPHROTIC SYNDROME ASSOCIATED WITH SPECIFIC CAUSES (SECONDARY NEPHROTIC SYNDROME) 21 Pathology patterns and clinical presentations of idiopathic nephrotic syndome 22 Renal biopsy. In adults, the nephrotic syndrome is a common condition leading to renal biopsy. In many studies, patients with heavy proteinuria and the nephrotic syndromes have been a group highly likely to benefit from renal biopsy in terms of a change in specific diagnosis, prognosis, and therapy. Selected adult nephrotic patients such as the elderly have a slightly different spectrum of disease, but again the renal biopsy is the best guide to treatment and prognosis (Table 2, 3).
23 PRIMARY NEPHROTIC SYNDROME. Minimal Change Disease. Focal Segmental Glomerulosclerosis. Membranous Nephropathy. Membranoproliferative Glomerulonephritis (MPGN) 24 Figure 5a. Pathology of glomerular disease. Light microscopy.
(a) Normal glomerulus minimal change disease. 25 Table 4 26 PRIMARY NEPHROTIC SYNDROME.
Minimal Change Disease. Focal Segmental Glomerulosclerosis. Membranous Nephropathy. Membranoproliferative Glomerulonephritis(MPGN) 27 Figure 5b. Segmental sclerosis focal segmental glomerulosclerosis. Light microscopic appearances in focal segmental glomerulosclerosis. Segmental scars with capsular adhesions in otherwise normal glomeruli.
29 Table 5 30 PRIMARY NEPHROTIC SYNDROME. Minimal Change Disease. Focal Segmental Glomerulosclerosis. Membranous Nephropathy. Membranoproliferative Glomerulonephritis(MPGN) 31 Figure 7a. Early MN a glomerulus from a patient with severe nephrotic syndrome and early MN, exhibiting normal architecture and peripheral capillary basement membranes of normal thickness (Silvermethenamine 400).
32 Figure 7b morphologically advanced MN 33 Figure 7c. Morphologically more advanced MN (same patient as in (b)) 34 Table 6 35 PRIMARY NEPHROTIC SYNDROME. Minimal Change Disease. Focal Segmental Glomerulosclerosis.
Membranous Nephropathy. Membranoproliferative Glomerulonephritis(MPGN) 36 Figure 8. Pathology of membranoproliferative glomerulonephritis type I. (a) Light microscopy shows a hypercellular glomerulus with accentuated lobular architecture and a small cellular crescent (methenamine silver). 37 Table 7 38 Diagnosis and Differential diagnosis 39.
Initial evaluation of the nephrotic patient includes laboratory tests to define whether the patient has primary, idiopathic nephrotic syndrome or a secondary cause related to a systemic disease. 40. Common screening tests include the fasting blood sugar and glycosylated hemoglobin tests for diabetes, and antinuclear antibody test for rheumatoid disease, and the serum complement, which screen for many immune complex-mediated disease (Table 3), In selected patients, cryoglobulins, hepatitis B and C serology, anti-neutrophil cytoplasmic antibodies (ANCAS), anti GBM antibodies, and other tests may be useful. Once secondary causes have been excluded, treating the adult nephrotic patient often requires a renal biopsy to define the pattern of glomerular involvement. 41 Complications Infection Coagulation disorders Protein malnutrition and dyslipidemia Acute renal failure.
It leads to a multitude of other consequences, such as predisposition to infection and hypercoagulability. In general, the diseases associated with NS cause chronic kidney dysfunction, but rarely they can cause ARF. ARE may be seen with minimal change disease, and bilateral renal vein thrombosis. 42 Treatment??
General treatment. 2. Symptomatic treatment (e.g.diuresis to relieve edema, treating dyslipidemias, anticoagulate treatment, etc.). 3.
Immunosupressive treatment???????????????????????????????? 43 Thank you.
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HTML code to embed chart as PNG Find more statistics at Statista. The most important statistics. Leading causes of death in the United States 2017. Mortality rates for older U.S. Adults with and without kidney disease 2016, by gender.
Mortality rates for older U.S. Adults with and without kidney disease 2016, by age. Mortality rates for older U.S. Adults with and without kidney disease 2016, by race. Kidney disease death rates in the U.S. In 2016, by state.
Kidney disease deaths in the U.S. In 2016, by state. Death rate from nephritis, nephrotic syndrome and nephrosis U.S. 1999-2015. Death rate from nephritis, nephrotic syndrome and nephrosis U.S. 2015, by age. Comorbidities.
The most important statistics. Rate of selected organ transplants in the U.S. 2017. Number of organ transplant candidates in the U.S. By organ 2018. Amount charged for select organ transplants in the U.S. As of 2017.
Length of stay in hospital for select organ transplants in the U.S. As of 2017. Waiting time for select organ transplants in the U.S. In 2011 and 2014.
Nephrotic Syndrome Ppt Presentation
Kidney transplant rates due to ESRD in the U.S. From 2012 to 2016, by age.
Nephrotic Syndrome In Adults
Most active kidney transplant centers in the U.S. In 2016, by number of transplants. Transplant outcomes.