【正文】 Age 1～ 6 ＞ 7 pathological change MCD MsPGN 、 MPGN 、 FSGS symptom four chief symptoms four chief symptoms ＋ hypertension＋ hematuria Albuminuria selective nonselective Complemen normal some reduce Renal function normal some reduce Urine FDP negative positive Reaction to good ， easy to relapse poor glucocorticoid course of the disease relieve in 4～ 8weeks delayed easy to relapse , 1～ 2year plication 1. infection URI, skin , urinary tract , peritonitis, etc. 2. hypovolemic shock 3. electrolyte disturbance hyponatremia , low potassium phosphate , hypocalcemia, etc. 4. thrombogenesis 5. acute renal failure 6. renal tubules malfunction 7. delayed growth treatment general treatment rest , diet, sodium 1～ 2g/day， intake VitD， calcium，protein ～ 2g/kg/day infection prevention vaccination 、 the infection problem during the glucocorticoid Detumescenceamp。diuresis pay attention to acidbase balanceamp。electrolyte disturbance Glucocorticoid treatment mechanism: decrease immunoreaction， improve capillary permeability ，reduce urine protein eduction. Decrease ADHamp。ALD， inncrease GFR, diuresis short range almost desuetude intermediate range ～ 2mg/Kg/d, tidqid , continue dose till 2 weeks after urine protein is change to negative(need 4 weeks to basically pleted ) The twothirds dose of the total dose of 2 days , qod ， 4weeks ， then reduce 5～ 10mg per 24weeks (need 6 months to basically pleted ) long range same as the intermediate range， then reduce ～ 5mg per 2~4weeks (need 9 months to basically pleted ) Long term low dose glucocorticoid (), would not lead to side effect. Enough dose at first, decrease dose slowly, maintenance dose should be long. immunosuppressor indication a. Frequent relapse： relapseamp。 reiteration 1year≥3 times、 6 months≥ twice。 b. Glucocorticoid dependence ： sensitive to glucocorticoid, can relieve， but relapse or reiteration in 2 weeks if dose reduction/drug withdrawal ， repeat 2～ 3 times 。 c. Glucocorticoid Resistant ： regular glucocorticoid treatment 8weeks ,urine protein ++ ～ ++++ immunosuppressor Cyclophosphamide per os : ～ 3mg/Kg/d， accumulated dose ＜ 200mg/Kg， course 3 months in vein stosstherapy : 8～ 12mg/Kg/time， accumulated dose ＜ 150mg/Kg, per 2 weeks ， gradually extend ntermittence according to condition hydrate at the first and last 3 days of stosstherapy 。 sex gland Chlorambucil Per os ： ,couse 6 months， accumulated dose ＜ 10mg/Kg。 Side effect ： sex gland CyclosporinA CsA CyA Azathioprine Mycophenolate （ FK506） Tacrolimus Anticoagulant amp。 fibrinolysis Heparin Sodium Heparin Calcium Urokinase Dipyridamole angiotensinconverting enzyme inhibitor mechanism: improve local glomerulus hemodynamics ， reduce albuminuria， delay glomerulus sclerosis Enalapril Maleate Tablets Benazepril Hydrochloride ACEI Sodium Fosinopril Losartan Potassium ARB chinese medcine improve general conditions ， mitigate drug sideeffect 雷公滕多甙片 inhibit cell immunity，antiinflammator, reduce albuminuria， per os ： 1～ ,bid ～ tid, couse 3 ~6 months。 sideeffect： sex gland prognosis simple NS 90～ 95% sensitive to glucocorticoid ， but easy to relapse。 nephritis NS partial evolve to ESRD in 10～ 15 years 思考題 1. 緊張性水腫與凹陷性水腫產(chǎn)生機理 ？ ， 請開出醫(yī)囑 。 Pathological types pathological changes distributing in glomerular disease focal : partial ＜５０％ glomerulus be inconvenienced diffuse : mostly＞５０％ glomerulus be inconvenienced pathological changes distributing in capillary loops of glomerulus segmental : partial ＜５０％ be inconvenienced glomerular : mostly＞５０％ be inconvenienced ０～１ mesangial cell in normal , ↑:mesangial proliferative