2. Definition NS is an accumulation of symptoms and signs and is characterized by proteinuria, hypoproteinemia, edema, and hyperlipidemia. In children under age 5 years the disease usually takes the form of idiopathic (primary) NS of childhood
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5. Pathogenesis The primary disorder is an increase in glomerular permea- bility to plasma proteins. *Foot processes of the visceral epithelium of the GBM. 1. The construction of the glomerular basement membrane has changed. 2. The loss of the negative charges on the GBM. * The underlying pathogenesis is unknown, but evidence strongly supports the importance of immune mechanisms.
6. Pathophysiology 1. Proteinuria: Fundamental and highly important change of pathophysiology. 2. Hypoproteinemia (mainly albumin) 3. Edema: Nephrotic edema (pitting edema) 4. Hyperlipidemia (Hypercholesterolemia) Ch↑, TG↑, LDL-ch↑,VLDL-ch↑.
7. Clinical Manifestations There is a male preponderance of 2:1. 1. Main manifestations: Edema (varying degrees) is the common symptom. Periorbital swelling and perhaps oliguria are noticed->increasing edema->anasarca evident. 2. General symptoms: Pallid, anorexia, fatigue,abdominal pain, diarrhea.
8. Laboratory Exam 1. Urinary protein: 2 + ～ 4 + 24hr total urinary protein > 0.1g/kg.( The most are selective proteinuria. )May occur granular and red cell casts. 2. Total serum protein↓, ＜ 30g/L .Albumin levels are low ( ＜ 20g/L). 3. Serum cholesterol and triglycerides: Cholesterol ＞ 5.7mmol/L (220mg/dl). 4. ESR↑ ＞ 100mm/hr.
