克莱尔肾病、肾病综合征(英文).ppt

Nephrotic and Nephritic Syndrome
Dr Claire Gibbons
FY2
Claire.******@.uk
Learning Objectives
Understand and define nephrotic and nephritic syndromes.
Describe the initial investigations and management of nephrotic and nephritic syndromes.
Describe plications of nephrotic and nephritic syndromes.
Draw a nephron!
Glomerulonephritis
Glomerulus – capillary loop with basement membrane which allows passage of specific molecules into the nephron
Glomerulonephritis – inflammation/damage of the glomerular basement membrane resulting in altered function. Relatively mon cause of kidney injury.
Can present as nephrotic and/or nephritic syndrome.
Nephrotic Syndrome
Triad of:
MASSIVE Proteinuria >3g/24hours
Or spot urine protein:creatinine ratio >300-350mg/mmol
Hypoalbuminaema <25g/L
Oedema
And often:
Hypercholesterolaemia/dyslipidaemia (total cholesterol >10mmol/L)
Presentation
New-onset oedema
Initially periorbital or peripheral
Later genitals, ascites, anasarca
Frothy urine
Generalised symptoms – lethargy, fatigue, reduced appetite
Further possible presentations...
Oedema
BP normal/raised
Leukonychia
Breathlessness:
Pleural effusion, fluid overload, AKI
DVT/PE/MI
Eruptive xanthomata/ xanthalosmata
You are a GP with the following patients...
Young, fit 24 year old plaining of frothy urine.
10 year old boy with puffy eyes.
74 year old female with multiple co-morbidities and swollen ankles.