1 infection Elderly people suffering from nephrotic syndrome, and immunity in hormones decreased significantly, prone to infection, and the infection of insidious onset, atypical clinical manifestations of this syndrome is also easy to caus...
Elderly people suffering from nephrotic syndrome, and immunity in hormones decreased significantly, prone to infection, and the infection of insidious onset, atypical clinical manifestations of this syndrome is also easy to cause urinary tract infection, but in urine cells do not easily diagnosis of urinary tract infection, urine culture should be done to distinguish whether is pay attention to bacterial infection, glucocorticoid is often exacerbated by bacterial infection, especially the susceptibility to TB infection, application of cytotoxic drugs, increased susceptibility to virus, infection site for the lungs, abdomen, meninges and lower urinary tract infection, once appear to choose sensitive antibiotic treatment should be timely, powerful and no renal toxicity. The elderly can take preventive measures such as vaccination and high immune serum globulin.
2 thrombosis, embolism
This is one of the serious syndrome of death, complications have been recognized, nephrotic syndrome, hypercoagulable state, and the intrinsic changes of coagulation, anticoagulation and fibrinolysis, to low protein, hyperlipidemia and blood concentration, blood viscosity increased intrinsic coagulation, thrombosis tendency serious, strong diuretic and long-term glucocorticoid aggravates this tendency, thrombosis, embolism nephrotic syndrome accounted for 8% to 50%, with renal vein thrombosis (RVT) is most common, membranous nephropathy patients can reach 50% or more, they can cause severe proteinuria, hematuria and renal function the whole, followed by in situ thrombosis of pulmonary artery and pulmonary vein formation, peripheral veins occur in the lower deep venous thrombosis and lower extremity deep vein, adult incidence was 6%, showed lower limb swelling, the elderly renal vein thrombosis, lower limb The incidence of thrombosis and pulmonary embolism was significantly higher than that of young people.
3 renal injury
(1) idiopathic acute renal failure: the pathogenesis of this disease is unknown, occurs in the nephrotic syndrome within 1 months, without any inducement of sudden oliguria, hematuria, renal function and acute exacerbations, given hydroxyethyl starch not only can not achieve a diuretic effect, but cause pulmonary edema, often requiring dialysis treatment can, spontaneous remission, recovery will take about 7 weeks, the acute renal failure occurred in patients over the age of 50, the pathology showed diffuse interstitial edema, renal tubular epithelial cell degeneration, necrosis, loss and regeneration of glomerular lesions is very light, more than 85% of mild lesions, because the patient for the elderly often accompanied by hyaline arterioles and elastic layer expansion, this disease should be differentiated from the following diseases:
The rapidly progressive glomerulonephritis;
Non steroidal anti-inflammatory drugs caused by acute interstitial nephritis, nephrotic syndrome may occur, often accompanied by systemic and renal manifestations of allergy;
Acute tubular necrosis due to infection;
Acute renal failure caused by nephrotic syndrome combined with double renal vein thrombosis, can be diagnosed after the above reasons.
(2) acute renal renal failure: mainly due to insufficient blood volume, usually with severe hypoproteinemia and excessive use of diuretics is strong, oliguria, anuria with insufficient blood volume performance (cold limbs, orthostatic blood pressure, pulse pressure, blood concentration, blood cell volume increase) at this time, the input of plasma expansion or treatment.
(3) renal tubular dysfunction: can cause diabetes, high uric acid, loss of potassium and loss of bicarbonate, the symptoms of glucocorticoid effect is poor, long-term prevention is poor.
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