pregnancy with nephrotic syndrome
Introduction
Introduction to pregnancy complicated with nephrotic syndrome Nephrotic syndrome is a group of syndromes characterized by proteinuria, hypoproteinemia, hypercholesterolemia, and marked edema caused by a variety of causes. The structural basis of glomerular filtration function is the glomerular filtration membrane, which has a three-layer structure, namely glomerular capillary endothelial cells, basement membrane and renal sac layer epithelial cells, among which there are many capillary endothelial cells. The small hole with a diameter of 50-100nm is called a window hole, which can prevent the passage of blood cells and has no blocking effect on plasma protein. The base film layer contains a micro-fiber network with a mesh of only 4-8 nm in diameter. This layer is filtered. The main filtration barrier of the membrane, the renal capsule epithelial cells have foot processes interdigitated to form a fissure, and the pore diameter is 4-14 nm. The above structure constitutes a barrier to protein filtration, once the barrier is damaged, the protein is filtered and When the loss exceeds a certain degree and time, the performance of kidney disease can occur clinically. basic knowledge The proportion of sickness: 0.01% Susceptible population: pregnant women Mode of infection: non-infectious Complications: malnutrition, renal vein thrombosis, pulmonary embolism, acute renal failure
Cause
Causes of pregnancy complicated with nephrotic syndrome
(1) Causes of the disease
Proliferative or membranous proliferative glomerulonephritis, fatty nephropathy, lupus nephritis, familial nephritis, diabetic nephropathy, syphilis, amyloidosis, renal vein thrombosis, heavy metal or drug poisoning, and allergies can cause the syndrome. The most common cause of nephrotic syndrome occurring in the third trimester of pregnancy is severe hypertensive disorder complicating pregnancy.
(two) pathogenesis
The structural basis of glomerular filtration function is the glomerular filtration membrane, which has a three-layer structure, namely glomerular capillary endothelial cells, basement membrane and renal sac layer epithelial cells, among which there are many capillary endothelial cells. The small hole with a diameter of 50-100nm is called a window hole, which can prevent the passage of blood cells and has no blocking effect on plasma protein. The base film layer contains a micro-fiber network with a mesh of only 4-8 nm in diameter. This layer is filtered. The main filtration barrier of the membrane, the renal capsule epithelial cells have foot processes interdigitated to form a fissure, and the pore diameter is 4-14 nm. The above structure constitutes a barrier to protein filtration, once the barrier is damaged, the protein is filtered and When the loss exceeds a certain degree and time, the performance of kidney disease can occur clinically.
As for the mechanism of hyperlipidemia caused by kidney disease, the mechanism of hyperlipidemia is secondary to abnormal protein metabolism. When the amount of urinary protein is lost, the synthesis of lipoprotein increases and the hyperlipidemia increases. The reason, in addition, the decrease in lipoprotein lipase activity reduces lipid clearance, which is also partly responsible.
Prevention
Pregnancy with nephrotic syndrome prevention
Keep the air in the living room fresh, not in crowded places, keep the skin clean, prevent skin damage, prevent infection, and promptly diagnose and treat infections. Easy to digest, light diet. Pay attention to the combination of physical and mental work and rest, enhance the body's immunity, pay attention to exercise. Regular review of urine routine and renal function.
Complication
Complications of pregnancy complicated with nephrotic syndrome Complications, adverse renal vein thrombosis, pulmonary embolism, acute renal failure
1. Infection is related to protein malnutrition and low level of immunoglobulin. Before the discovery of antibiotics, patients with this syndrome mainly die from infection. Common infection sites include respiratory tract, urinary tract, skin and primary peritonitis. Clinical manifestations are often not Obvious (especially when applying glucocorticoid therapy).
2. Thrombosis, embolic complications and blood concentration, high viscosity state, anticoagulant factor deficiency and fibrinolysis mechanism disorders, the incidence rate is 10% to 50%, mostly renal vein thrombosis, followed by lower extremity venous thrombosis, and even coronary vessels Thrombosis, may be associated with fatal pulmonary embolism.
3. Malnutrition In addition to atrophy caused by protein malnutrition, children's growth and development disorders, there are vitamin D deficiency, calcium and phosphorus metabolism disorders, secondary hyperparathyroidism, small cell type (iron deficiency) anemia, zinc deficiency Malnutrition caused by fatigue, slow wound healing and copper deficiency.
4. Renal function damage may result in a decrease in renal blood flow due to insufficient circulating blood volume, transient renal azotemia, expansion, diuretic recovery, and no hypovolemia, no Any sudden cause of sudden deterioration of renal function, the expansion of colloidal solution can not diuretic but cause pulmonary edema, often requiring dialysis treatment, more than 7 weeks of natural remission, called idiopathic acute renal failure, can also cause True tubular necrosis or proximal tubular dysfunction.
Symptom
Symptoms of pregnancy complicated with nephrotic syndrome Common symptoms Circulatory failure, low blood pressure, low blood pressure, low head, dizziness, loss of appetite, facial edema, late edema
1. The edema is more common in the ankle, which is concave, and then extends to the whole body. The facial edema is obvious when getting up in the morning, often accompanied by fatigue, dizziness, loss of appetite, nausea, vomiting, etc.
2. Patients with cardiovascular system symptoms have low blood pressure, small pulse pressure, and easy fainting. When improper use of blood pressure, diuretics may cause significant hypotension, even circulatory failure, shock and so on.
Examine
Examination of pregnancy complicated with nephrotic syndrome
1. Urine examination 24h urine protein quantitative> 3g / d, the highest can reach 5g / d or more, combined with other kidney diseases, red, white blood cells and / or cells and granules.
2. Biochemical determination of cholesterol and blood lipid levels increased; albumin levels decreased, white, globulin ratio inverted; blood urea nitrogen, creatinine can be increased to varying degrees.
3. The blood glucose levels in the laboratory of other related diseases are increased, the syphilis serum is positive, and the autoantibody or antinuclear antibody is positive.
Diagnosis
Diagnosis and differential diagnosis of pregnancy complicated with nephrotic syndrome
diagnosis
Detailed medical history to determine the cause, according to: 1 large amount of proteinuria, more than 3.5g per day; 2 hypoproteinemia, total plasma protein less than 5g%, albumin less than 3g%; 3 systemic edema; 4 hypercholesterolemia (>300mg% or more); 5 lipid urine, can be diagnosed as nephrotic syndrome.
Differential diagnosis
1. Allergic purpuric nephritis occurs in children and adolescents, with a typical rash, may be associated with joint pain, abdominal pain and melena, rash occurs after 1 to 4 weeks of kidney damage, some nephrotic syndrome, but typical skin Positive sputum and beam-hip test are helpful for differential diagnosis.
2. Lupus nephritis occurs in young, young women, showing multiple system damage, serum complement C3 continues to decrease, circulating immune complexes are positive, a variety of autoantibodies appear, kidney disease is partially manifested as nephrotic syndrome, multi-system damage, especially It is a serological, immunological examination that helps to differentiate the diagnosis.
3. Diabetic nephropathy occurs in middle and old age. After several years of diabetes, urine changes occur, protein appears in the urine, and nephrotic syndrome changes gradually. The history of primary disease is meaningful for differential diagnosis.
4. Renal amyloidosis occurs in middle and old age, amyloidosis is divided into primary and secondary, the former is unclear, mainly invading the heart, kidney, digestive tract, skin and nerves, the latter often secondary to Chronic suppurative infections and malignant tumors, renal changes are mainly characterized by increased volume, often with nephrotic syndrome, confirmed by biopsy pathological examination, Congo red staining is a characteristic change of the disease.
5. Myeloma nephropathy occurs in the middle, the elderly, more men than women, may have bone pain, flat bone X-ray examination of the medullary cavity, serum globulin increased, M protein banding of plasma protein electrophoresis, urine coagulation Lysin positive, the disease is nephrotic syndrome when the kidney is involved, the diagnosis requires bone marrow puncture, a large number of myeloma cells can be seen.
