Common symptoms: edema, proteinuria, hypoproteinemia, hypertension, hypotension, hematuria
What are the manifestations and diagnosis of minimal change nephropathy?
Peak age in children aged 2 to 6. Adults 30 to more than 40 years of age, more than 60 years of age in patients with nephrotic syndrome, the incidence of minimal change nephropathy. The proportion of male and female children was 2 times that of adults. About 1/3 of patients with upper respiratory tract infection or other infections. Most of the onset of acute, typical cases of the first symptoms are obvious nephrotic syndrome, accounting for 90% of children with nephrotic syndrome, adult of 20%. Normal blood pressure. 20% of the patients showed different degrees of hematuria, with the increase of age, the incidence of hematuria was also increased, especially in patients over the age of 60 years, due to renal interstitial inflammation, fibrosis and vascular lesions, hematuria occurred more frequently. But gross hematuria is rare. Glomerular filtration rate decreased in patients with 1/3 for the first time because of low blood volume and decreased renal perfusion. Urine sediment examination without cells or casts. In severe cases 24 hours urine protein can exceed 40g.
The urine protein is highly selective proteinuria in children with typical patients, mainly including albumin and a very small amount of high molecular weight proteins such as IgG, 2-, C3 alpha macroglobulin, adult performance, minimal change disease in elderly patients over the age of 60 can be expressed as a non selective proteinuria and glomerular hypertension, and often accompanied by filtration rate decreased. In recent years, found that the molecular weight of 88000 transferrin, as the ball type and its structure characteristics, with albumin leakage into the tubular fluid, while pH is 4.5 ~ 5.5 in the urine, transferrin iron free will to the tubular fluid, Fe3+ can produce a lot of oxygen free radical injury of renal tubule interstitial, and also can be directly Fe3+ the damage of renal tubule and interstitial. Urinary fibrin free lysate and C3. The complement components in blood were normal, but C1q decreased slightly. The IgG concentration was generally low during the attack period, while IgM increased slightly in the attack and remission stage. The histocompatibility antigen HLA-B12 was significantly more common in minimal change nephropathy, suggesting that the disease may be related to heredity. The titer of anti O antibody was significantly decreased.
Minimal change disease should be noticed except with Hodgkin's disease. In addition, in the nephrotic syndrome caused by nonsteroidal anti-inflammatory drugs, histology can be similar to minimal change nephropathy, but is usually associated with interstitial nephritis and decreased renal function.
In rare cases, acute renal failure occurs when there is no significant low blood volume. As a result of hypoproteinemia leading to decreased blood colloid osmotic pressure, blood volume caused by a serious shortage of pre renal interstitial blood disease seen in only 7% to 38% patients. If there is no typical clinical manifestations of insufficient blood volume, urine concentration decreased function of urinary sodium excretion increased, especially in giving blood products or albumin urine volume does not increase should be considered into the kidney of acute renal failure, this time should be considered in addition to drug induced acute tubular necrosis (nephrotoxic drugs such as amino glycoside gentamicin) or acute interstitial nephritis (antibiotics, nonsteroidal anti-inflammatory drugs, etc.), should also be aware of a special kind of acute renal failure.
Nephrotic syndrome is associated with idiopathic oliguria acute renal failure (change) or mild mesangial proliferative glomerulonephritis (mesangial proliferative GN), which is the underlying glomerular disease of acute renal failure (minimal). More common in older, more severe nephrotic syndrome, blood pressure, especially higher systolic blood pressure with vascular sclerosis. In addition to minimal change nephropathy, the pathological changes of proximal renal tubular epithelial cells were flat, brush border, and (or) renal interstitial edema, but no typical tubular necrosis or interstitial nephritis. Because of the slight change of pathological changes in acute renal failure complicated with acute renal failure, it is a kind of pathological change. Although the blood volume and renal blood flow were approximately normal, glomerular filtration rate (GFR) showed a transient decrease, and the filtration index (FF) decreased. The two components of single nephron glomerular filtration rate had obvious changes: Ultrafiltration index (ultrafiltration coeffecient) declined more than 50%; due to intravascular colloid osmotic pressure decreased, the net ultrafiltration pressure (net driving force, which cross the capillary membrane hydrostatic pressure P- intravascular colloid pressure outside the delta PI) increased, renal interstitial edema.
Beijing In China