Kodner Charles
University of Louisville School of Medicine, Louisville, KY, USA.
Am Fam Physician. 2016 Mar 15;93(6):479-85.
Nephrotic syndrome (NS) consists of peripheral edema, heavy proteinuria, and hypoalbuminemia, often with hyperlipidemia. Patients typically present with edema and fatigue, without evidence of heart failure or severe liver disease. The diagnosis of NS is based on typical clinical features with confirmation of heavy proteinuria and hypoalbuminemia. The patient history and selected diagnostic studies rule out important secondary causes, including diabetes mellitus, systemic lupus erythematosus, and medication adverse effects. Most cases of NS are considered idiopathic or primary; membranous nephropathy and focal segmental glomerulosclerosis are the most common histologic subtypes of primary NS in adults. Important complications of NS include venous thrombosis and hyperlipidemia; other potential complications include infection and acute kidney injury. Spontaneous acute kidney injury from NS is rare but can occur as a result of the underlying medical problem. Despite a lack of evidence-based guidelines, treatment consisting of sodium restriction, fluid restriction, loop diuretics, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, and careful assessment for possible disease complications is appropriate for most patients. Renal biopsy is often recommended, although it may be most useful in patients with suspected underlying systemic lupus erythematosus or other renal disorders, in whom biopsy can guide management and prognosis. Immunosuppressive treatment, including corticosteroids, is often used for NS, although evidence is lacking. Routine prophylactic treatment to prevent infection or thrombosis is not recommended. A nephrologist should be consulted about use of anticoagulation and immunosuppressants, need for renal biopsy, and for other areas of uncertainty.
肾病综合征(NS)表现为外周水肿、大量蛋白尿和低白蛋白血症,常伴有高脂血症。患者通常表现为水肿和疲劳,无心力衰竭或严重肝病的证据。NS的诊断基于典型临床特征以及大量蛋白尿和低白蛋白血症的确认。患者病史和选定的诊断检查可排除重要的继发性病因,包括糖尿病、系统性红斑狼疮和药物不良反应。大多数NS病例被认为是特发性或原发性的;膜性肾病和局灶节段性肾小球硬化是成人原发性NS最常见的组织学亚型。NS的重要并发症包括静脉血栓形成和高脂血症;其他潜在并发症包括感染和急性肾损伤。NS自发的急性肾损伤很少见,但可因潜在的医学问题而发生。尽管缺乏循证指南,但对大多数患者而言,采用限钠、限液、襻利尿剂、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗以及仔细评估可能的疾病并发症的治疗方法是合适的。通常建议进行肾活检,尽管它可能对疑似潜在系统性红斑狼疮或其他肾脏疾病的患者最有用,在这些患者中活检可指导治疗和判断预后。免疫抑制治疗,包括使用皮质类固醇,常用于NS,尽管缺乏证据。不建议进行常规预防性治疗以预防感染或血栓形成。应就抗凝剂和免疫抑制剂的使用、肾活检的必要性以及其他不确定领域咨询肾病科医生。