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Sindrom Nefrotic Flashcards

(47 cards)

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1
Q

Cum sunt edemele?

A

Generalizate (scade albumina)

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2
Q

Care e clasificarea etiologica?

A

1.primitiv idiopatic: SN PUR(nefroza lipoida)
2.boli genetice cu SN asociat sau proteinurie
3.SN secundar altor boli

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3
Q

Exemple de SN primitiv idiopatic

A

SN pur=nefroza lipoida
Glomeruloscleroza
GN membrano-proliferativa
Nefropatia membranoasa

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4
Q

Boli genetice asociate cu proteinurie

A

SN congenital/familial
Alte sdr genetice

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5
Q

SN secundar

A

Boli cardiovasculare
Medicamente, toxice
Boli de sistem
Cauze infectioase
B neoplazice
B metabolice

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6
Q

Exemple SN cardiovasculare

A

Pericardita constrictiva, tromboza de v. renala

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7
Q

SN secundar medicamentelor, toxice

A

Penicilamina, saruri de aur, metale grele, AINS, intepaturi de albine, muscaturi de sarpe

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8
Q

SN secundar boli de sistem

A

Colagenoze (LES), purpura Henoch-Schonlein

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9
Q

SN secundar unor cauze infectioase:

A

Lues congenital, toxoplasmoza, HIV, Hepatita B,C, CMV, vEB, malarie, TBC

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10
Q

SN secundar unor boli neoplazice

A

Leucemie, limfom Hodgkin, tumori solide, feocromocitom

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11
Q

SN secundar unor boli metabolice

A

Diabet zaharat, amiloidoza

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12
Q

Cum se clasifica SN din punct de vedere evolutiv?

A

SN pur-fara hematurie, HTA, retentie de azotati (sau poate sa aiba doar in prima luna)
SN impur-persistenta 1/3: hematurie, HTA, retentie azotata

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13
Q

Care e fiziopatologia SN?

A
  1. Mecanism imun: prin CIC, ac anti MBG, alergie de tip reaginic
  2. Mecanism toxic
    3.Mecanisme patogenice incomplet elucidate(nefroza lipoida)
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14
Q

Ce apare secundar hipoalbuminemiei in legatura cu lipidele?

A

Hiperlipemie
Hiper beta LPemie
Hipercolesterolemie
Lipidurie
SCADE LIPOPROTEINLIPAZA

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15
Q

Ce existe in antecedente la SN pur?

A

infectii virale, vaccinuri, intepaturi de insecte

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16
Q

Care ar fi mecanismul din spatele nefrozei lipoide?

A

Produc limfokine toxice pe MBG

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17
Q

Cand se manifesta SN pur?

A

La 2-5 ani

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18
Q

Cum se manifesta SN pur?

A

Paloare, inapetenta, edeme progresive, oligurie
SDR EDEMATOS, OLIGURIE
TA normala
Manifestari GI
Malnutritie
Dificultati respiratorii
Tulb CV
Tendinta la infectii
Complicatii tratament

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19
Q

Cum se manifesta SN pur?

Study These Flashcards
A

Paloare, inapetenta, edeme progresive, oligurie
SDR EDEMATOS, OLIGURIE
TA normala
Manifestari GI
Malnutritie
Dificultati respiratorii
Tulb CV
Tendinta la infectii
Complicatii tratament

20
Q

Examenul de urina:

Study These Flashcards
A

Proteinurie, spumeaza usor
Ph acid, proteinurie
Albuminurie, creste transferina, creste IgG
Raport proteine/creatinina peste 0.2
RAR: cilindri, cruci de Malta

21
Q

Cum e urina in 24h?

Study These Flashcards
A

Proteinurie
Electroforeza prot: albumina, transferina, Ig G crescute

22
Q

Ionograma urinara

Study These Flashcards
A

K crescut si Na scazut (efectul aldosteronului care reabs Na si excreta K)

23
Q

Ce globuline cresc in SN pur?

Study These Flashcards
A

Alfa globuline si beta globuline ptc ficatul compenseaza pierderea proteinelor

24
Q

Cum e RFG in SN pur?

25
Poate aparea anemia in SN pur?
Da, prc scade sinteza de proteine si scade si transferina
26
Cum e VSH, aslo?
VSH e crescut (ptc hipoalbuminemia stimuleaza formarea de fibrinogen si PCR) ASLO negativ ca nu apare dupa inf streptococice
27
Dg diferential edeme
ICC Carente proteice Boli hepatice cronice Endocrine-mixedem Alergice Limfedem Renale
28
Care sunt edemele renale?
ITU perioada scurta si sunt reduse GNA: Sd nefritic, insf streptococica, ASLO crescut SN pur
29
Ce elemente sugereaza SN impur?
Debut la fete peste 10 ani Hematurie, retentie de azotati, HTA persistente Simptomatologie asociata:rash, altralgii, Expunere la medicamente, toxice
30
Care e tratamentul in SN pur
Regim-hiposodat, normocaloric, adm de proteine, de carbohidrati, K Restrictie lipidica Restrictie lichide in perioada cu edeme
31
Care este tratamentul patogenic?
CT-prednison zilnic timp de 4-6 saptamani pana la remisie Apoi prednison 8s-5luni cu scaderea treptata a dozei citostatice: ciclofosfamida/ clorambucil+CT doze mici
32
Cum ne dam seama ca e SN corticosensibil?
Apare remisia dupa 4-6 saptamani de CT Scade raportul prot/creatinina Absenta proteinuriei 3 zile consecutiv
33
Cum ne dam seama ca e vorba de recadere in SN?
Persistenta proteinuriei 3 zile consecutiv Raportul prot/creatinina crescut peste 0.2
34
SN cu recaderi frecvente
Apar minim 2-3 recaderi in 6 luni Sau minim 4 intr un an
35
SN corticodependent
Recadere odata cu scaderea dozei Sau la 2 sapt de la adm continua
36
Cum se ajunge de la SN corticodependent la rezistent?
Dupa adm dozei de atac, nu raspunde la tratament=>rezistent
37
Ce se face in cazul SN corticorezistent?
PBR=punctie biopsie renala si pulsterapie cu metilprednisolon iv si apoi per os 27 de zile
38
Indicatii pentru citostatice
SN corticosensibil cu recaderi frecvente SN corticodependent SN corticosensibil cu corticointoleranta Si la unele SN corticorezistente
39
CI pentru citostatice
SN congenital sau familial SN steroid rezistente (cu exceptie LES, GN mb proliferativa) Formele corticosensibile cu toleranta la ct (fara corticointoleranta)
40
Care este tratamentul simptomatic?
Diuretice, albumina umana, punctii evacuatorii
41
Spre ce pot evolua SN CT rezistente?
Spre glomeruloscleroza->IRC->EXITUS
42
SN corticodependent
Reapare proteinuria dupa scaderea dozei de prednison in primele 14 zile
43
SN corticorezistent
Nu raspunde la doza de atac dupa 1-2 luni
44
Complicatiile bolii
infectii recurente Retentie hidrosalina masiva cronica Soc hipovolemic Fenomene tromboembolice (CT, stare de hipercoagulabilitate, scaderea fibrinolizei, traumatisme vasculare) ITU
45
Complicatiile CORTICOTERAPIEI
Cv- supraincarcare Sist hematopoietic: leucocitoza GI: hepatomegalie, meteorism (K mult da pareza intestinala) Endocrine CSR DZ ochi cataracta Tegumente: striatii cortizonice, acnee, hirsutism SNC despresie, psihoze OS scade cresterea in lungime, necroza aseptica de cap femural Imunologice: scade rez la inf Generale: obezitate, apetit crescut
46
Complicatiile citostaticelor
GI varsaturi, diaree hemoragica MO- depresie L Alopecie Cistita hemoragica Sterilitate Varicela letala Ef teratogen
47
Cu ce vaccinuri nu se pot vaccina cei sub tratament pt SN?
Cu vaccinuri vii ptc iau CT

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