Nephrotic syndrome diagnosis and differential diagnosis

The diagnosis includes three aspects:
① confirmed NS;
② confirmation of etiology: First of all, except the secondary cause of genetic disease can be diagnosed as primary the NS; best renal biopsy to make a pathological diagnosis;
(3) determine whether the complication.
Ns of the need for differential diagnosis of secondary causes include the following diseases:
1, anaphylactoid purpura nephritis occurs in adolescence, the typical skin purpura may be associated with joint pain, abdominal pain and melena, hematuria and proteinuria, (or) a typical rash appears in more than l ~ 4 weeks after the rash appears will help on differential diagnosis.
, Systemic lupus erythematosus occurs in young and middle-aged women, the clinical manifestations and immunological tests based on multi-system damage can be detected in a variety of autoantibodies, generally is not difficult to confirm the diagnosis.
Hepatitis B virus (HBV) associated glomerulonephritis is more common in children and adolescents, proteinuria or NS as the main clinical manifestations of common pathological type of membranous nephropathy, followed by mesangial capillary glomerulonephritis. The following three points of the domestic basis for diagnosis: (1) serum HBV antigen-positive; (2) suffering from glomerular nephritis, and may, except lupus nephritis secondary glomerulonephritis; ③ renal biopsy slices to find the HBV antigens. Of viral hepatitis B high incidence of viral hepatitis B patients, children and young people proteinuria or NS patients, especially for film. Nephropathy, should be carefully to exclude.
4, diabetic nephropathy occurs in middle-aged, NS is common in patients with diabetes duration of more than lO years. Early can be found in the urinary albumin excretion increased, then gradually developed into a massive proteinuria NSo history of diabetes and the characteristic fundus changes helpful in differential diagnosis.
5, renal amyloidosis occurs in middle-aged, renal amyloidosis is part of multiple organ involvement. Primary amyloid degeneration mainly involving the heart, kidneys, digestive tract (including tongue), skin and nerves; secondary amyloidosis often secondary to chronic suppurative infections, tuberculosis, cancer and other diseases, mainly involving the kidney, liver and the spleen and other organs. Kidney involvement, increase in size, often has the NS. Renal amyloidosis often need renal biopsy diagnosis.
6, myeloma kidney disease occurs in middle-aged, male predominance, the patients may have clinical features of multiple myeloma, such as bone pain, increased serum monoclonal immunoglobulin, protein electrophoresis of M protein and urine Bence The protein is positive, bone marrow plasma cell dysplasia (more than the possession of nuclear cells in 159/5), accompanied by a qualitative change. Multiple myeloma involving the glomerular NS. The characteristic performance of the above myeloma differential diagnosis.