The five classification of nephrotic syndrome2017-01-24 16:26
The five classification of nephrotic syndrome
Clinical pathology type and clinical manifestation of nephrotic syndrome:
1. minimal change nephrotic syndrome
Under the electron microscope has a wide range of Glomerular visceral epithelial foot process fusion. No electron-dense material. More men than women, it occurs in children, old age is on the rise, typical for the rare nephrotic syndrome hematuria, usually without persistent high blood pressure and kidney dysfunction. More than 90% patient is sensitive to glucocorticoid therapy, but easy to relapse.
2. the mesangial proliferative Glomerulonephritis
Visible under the light microscope in Glomerular mesangial cells and diffuse hyperplasia of mesangial matrix.
IgA deposits of IgA nephropathy, with C3, non-IgA IgM or IgG deposits, with C3, in the mesangium and Glomerular Capillary Wall is granular deposits.
More males than females, occur in young people, half in acute onset after upper respiratory tract infection, some latent disease. IgA nephropathy in nephrotic syndrome, 15%, non-IgA nephrotic syndrome 30%, 70% with the urine.
3. mesenteric capillary Glomerulonephritis
Mesangial cells under light microscopy and severe hyperplasia of mesangial matrix, inserted in the Glomerular basement membrane and endothelial cells in the capillary loops "double track sign." (typical features to keep in mind).
Immune pathological IgG,C3 grainy deposit in mesangial area and capillary walls. More men than women, more common in young adults, assuming a infection, morbidity is anxious, manifested as acute nephritic syndrome and nephrotic syndrome. Almost all patients have hematuria.
Renal dysfunction, high blood pressure and anemia occurs early, continued progress in disease, disease progress faster. Hormones and cytotoxic drugs, poor outcome. About half of the cases progress to chronic renal failure after 10 years of onset.
4. the membranous nephropathy: early epithelial basement membrane side is visible under the light microscope neat complex of Red particles (Masson stain) then formed Rete pegs (Silver staining), gradually thickening of basement membrane. If Rete pegs formed, foot process extensive integration.
More men than women, and occurs in middle-aged and old, insidious onset, characterized by kidney test, test sites collected disease syndrome, but with microscopic hematuria. Incidence of renal impairment in 5-10 years later, easily concurrent thromboembolism. A few spontaneous remission and early treatment response rate high, disease, poor outcome.
5. Focal Segmental Glomerulosclerosis: under the microscope of focal and Segmental Glomerulosclerosis in first violation of Glomerular vascular pole position next to the spinal cord. Renal tubular atrophy, interstitial fibrosis. Involvement of IgM and C3 in the segment are massive deposits. Occurs in adolescent males, insidious onset, characterized by nephrotic syndrome, about 75% in patients with hematuria diagnosed often have high blood pressure and kidney dysfunction. In most proximal tubule dysfunction. Poor effects of hormones and cytotoxic drugs, gradually developed into kidney failure.