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Pedi > Sindrom Nefrotic > Flashcards

Sindrom Nefrotic Flashcards

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?

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:

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?

A

Proteinurie
Electroforeza prot: albumina, transferina, Ig G crescute

22
Q

Ionograma urinara

A

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

23
Q

Ce globuline cresc in SN pur?

A

Alfa globuline si beta globuline ptc ficatul compenseaza pierderea proteinelor

24
Q

Cum e RFG in SN pur?

A

Normal

25
Q

Poate aparea anemia in SN pur?

A

Da, prc scade sinteza de proteine si scade si transferina

26
Q

Cum e VSH, aslo?

A

VSH e crescut (ptc hipoalbuminemia stimuleaza formarea de fibrinogen si PCR)
ASLO negativ ca nu apare dupa inf streptococice

27
Q

Dg diferential edeme

A

ICC
Carente proteice
Boli hepatice cronice
Endocrine-mixedem
Alergice
Limfedem
Renale

28
Q

Care sunt edemele renale?

A

ITU perioada scurta si sunt reduse
GNA: Sd nefritic, insf streptococica, ASLO crescut
SN pur

29
Q

Ce elemente sugereaza SN impur?

A

Debut la fete peste 10 ani
Hematurie, retentie de azotati, HTA persistente
Simptomatologie asociata:rash, altralgii,
Expunere la medicamente, toxice

30
Q

Care e tratamentul in SN pur

A

Regim-hiposodat, normocaloric, adm de proteine, de carbohidrati, K
Restrictie lipidica
Restrictie lichide in perioada cu edeme

31
Q

Care este tratamentul patogenic?

A

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
Q

Cum ne dam seama ca e SN corticosensibil?

A

Apare remisia dupa 4-6 saptamani de CT
Scade raportul prot/creatinina
Absenta proteinuriei 3 zile consecutiv

33
Q

Cum ne dam seama ca e vorba de recadere in SN?

A

Persistenta proteinuriei 3 zile consecutiv
Raportul prot/creatinina crescut peste 0.2

34
Q

SN cu recaderi frecvente

A

Apar minim 2-3 recaderi in 6 luni
Sau minim 4 intr un an

35
Q

SN corticodependent

A

Recadere odata cu scaderea dozei
Sau la 2 sapt de la adm continua

36
Q

Cum se ajunge de la SN corticodependent la rezistent?

A

Dupa adm dozei de atac, nu raspunde la tratament=>rezistent

37
Q

Ce se face in cazul SN corticorezistent?

A

PBR=punctie biopsie renala si pulsterapie cu metilprednisolon iv si apoi per os 27 de zile

38
Q

Indicatii pentru citostatice

A

SN corticosensibil cu recaderi frecvente
SN corticodependent
SN corticosensibil cu corticointoleranta
Si la unele SN corticorezistente

39
Q

CI pentru citostatice

A

SN congenital sau familial
SN steroid rezistente (cu exceptie LES, GN mb proliferativa)
Formele corticosensibile cu toleranta la ct (fara corticointoleranta)

40
Q

Care este tratamentul simptomatic?

A

Diuretice, albumina umana, punctii evacuatorii

41
Q

Spre ce pot evolua SN CT rezistente?

A

Spre glomeruloscleroza->IRC->EXITUS

42
Q

SN corticodependent

A

Reapare proteinuria dupa scaderea dozei de prednison in primele 14 zile

43
Q

SN corticorezistent

A

Nu raspunde la doza de atac dupa 1-2 luni

44
Q

Complicatiile bolii

A

infectii recurente
Retentie hidrosalina masiva cronica
Soc hipovolemic
Fenomene tromboembolice (CT, stare de hipercoagulabilitate, scaderea fibrinolizei, traumatisme vasculare)
ITU

45
Q

Complicatiile CORTICOTERAPIEI

A

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
Q

Complicatiile citostaticelor

A

GI varsaturi, diaree hemoragica
MO- depresie L
Alopecie
Cistita hemoragica
Sterilitate
Varicela letala
Ef teratogen

47
Q

Cu ce vaccinuri nu se pot vaccina cei sub tratament pt SN?

A

Cu vaccinuri vii ptc iau CT

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