Kodner Charles
Department of Family and Geriatric Medicine, University of Louisville School of Medicine, Louisville, KY 40292, USA.
Am Fam Physician. 2009 Nov 15;80(10):1129-34.
Nephrotic syndrome may be caused by primary (idiopathic) renal disease or by a variety of secondary causes. Patients present with marked edema, proteinuria, hypoalbuminemia, and often hyperlipidemia. In adults, diabetes mellitus is the most common secondary cause, and focal segmental glomerulosclerosis and membranous nephropathy are the most common primary causes. Venous thromboembolism is a possible complication; acute renal failure and serious bacterial infection are also possible, but much less common. There are no established guidelines on the diagnostic workup or management of nephrotic syndrome. Imaging studies are generally not needed, and blood tests should be used selectively to diagnose specific disorders rather than for a broad or unguided workup. Renal biopsy may be useful in some cases to confirm an underlying disease or to identify idiopathic disease that is more likely to respond to corticosteroids. Treatment of most patients should include fluid and sodium restriction, oral or intravenous diuretics, and angiotensin-converting enzyme inhibitors. Some adults with nephrotic syndrome may benefit from corticosteroid treatment, although research data are limited. Intravenous albumin, prophylactic antibiotics, and prophylactic anticoagulation are not currently recommended.
肾病综合征可能由原发性（特发性）肾脏疾病或多种继发性病因引起。患者表现为明显水肿、蛋白尿、低白蛋白血症，且常伴有高脂血症。在成年人中，糖尿病是最常见的继发性病因，局灶节段性肾小球硬化症和膜性肾病是最常见的原发性病因。静脉血栓栓塞是一种可能的并发症；急性肾衰竭和严重细菌感染也有可能发生，但较为少见。目前尚无关于肾病综合征诊断检查或管理的既定指南。一般不需要进行影像学检查，血液检查应选择性地用于诊断特定疾病，而非进行广泛或无针对性的检查。肾活检在某些情况下可能有助于确诊潜在疾病或识别更可能对皮质类固醇有反应的特发性疾病。大多数患者的治疗应包括限制液体和钠摄入、口服或静脉使用利尿剂以及血管紧张素转换酶抑制剂。一些患有肾病综合征的成年人可能从皮质类固醇治疗中获益，尽管研究数据有限。目前不推荐静脉输注白蛋白、预防性使用抗生素和预防性抗凝治疗。
