Nephrotic syndrome (NS) by a variety of causes, in order to increase the permeability of the glomerular basement membrane, showed massive proteinuria, hypoalbuminemia, severe edema, a clinical syndrome of hyperlipidemia.
Diagnosis
1. nephrotic syndrome (NS) diagnostic criteria are:
(1) greater than 3.5g / d proteinuria.
(2) serum albumin less than 30 g / L.
(3) Edema.
(4) Hyperlipidemia.
2 DK diagnosis should include three aspects.
(1) Diagnosed NS.
(2) Confirm the cause: First rule out secondary and inherited diseases can be diagnosed with primary NS, better renal biopsy for pathological diagnosis.
(3) Judgment uncomplicated.
Differential Diagnosis
1. Purple allergic nephritis
Especially in young, with typical purple skin, often in symmetrical distal extremities, 1 to 4 weeks hematuria and (o) proteinuria after more than a rash.
2. Systemic lupus nephritis
Most often in middle-aged women and youth. Immunological examination showed a variety of autoantibodies and multiple system damage, can confirm the diagnosis.
3. Hepatitis B virus associated glomerulonephritis
It is more common in children and adolescents, the main clinical manifestations of proteinuria or NS, common pathologic type of membranous nephropathy. The diagnosis is based on ① HBV antigen positive serum. ② The suffering of glomerulonephritis, and excludes secondary glomerulonephritis. ③ biopsy slice HBV antigens found.
4. Diabetic nephropathy
Occur in the elderly, is common in patients with diabetes duration of more than 10 years. Early can be found in urinary albumin excretion increased, then gradually became a massive proteinuria, NS. History of diabetes and fund changes characteristic eye contribute to the differential diagnosis.
5. Renal amyloidosis
Occur in the elderly, renal amyloidosis is a part of the involvement of multiple organs. Primary amyloidosis primarily involving the heart, kidneys, gastrointestinal tract (including language), skin and nerves; secondary amyloidosis often secondary to chronic suppurative infections, tuberculosis, cancer and other diseases, which mainly involves the kidneys, liver and spleen and other organs. Volume increases renal involvement, often NS. Renal amyloidosis often require biopsy confirmed.
6. Myeloma nephropathy
It occurs most commonly in men middle-aged patients may have clinical features of multiple myeloma, such as bone pain, elevated serum monoclonal immunoglobulin protein electrophoresis and urine with the M protein positive this week, shows plasma cells bone marrow dysplasia (occupy more than 15% of the nucleated cells), and accompanied by a qualitative change. Multiple myeloma can occur when the glomerular involvement of NS. Demonstrations myeloma above features for the differential diagnosis.
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