339.4 📋 章末速蚘 Summary

339.4.1 🔑 䞀句話瞜結

Glomerular diseases = 圱響 glomerulus 的疟病nephrotic syndrome 經兞 5 倧特埵 = proteinuria > 3.5 g/24h + hypoalbuminemia + edema + hyperlipidemia ± hypercoagulabilitynephritic syndrome = hematuria + RBC casts + HTN + AKI variable + edema + proteinuria variabletop nephrotic causesMCD (children most), FSGS (adults in US most common), MN (older adults — anti-PLA2R 70-80%), DKD (globally most common), amyloidosis, MPGNsecondary causes hep B/C, HIV, drugs (NSAIDs, lithium, ICI), cancer (paraneoplastic), pregnancytop nephritic causesIgA nephropathy (globally most common), PSGN, lupus nephritis (Class I-VI ISN/RPS), ANCA-associated (GPA, MPA, EGPA), anti-GBM (Goodpasture), MPGN/C3G, IgA vasculitis (HSP), cryoglobulinemic (Hep C)RPGN 3 types: anti-GBM (Type I) + immune complex (Type II — lupus, post-infectious) + pauci-immune (Type III — ANCA)workupUA + UACR + 24h urine + serum chemistry + immunology (ANA, dsDNA, ANCA, anti-GBM, anti-PLA2R, ASO, complement C3/C4, RF, cryoglobulin) + hepatitis + HIV + free light chains → renal biopsy gold standard (LM + IF + EM)supportive treatmentACE/ARB (reduce proteinuria + BP), diuretics, statins, anticoagulation for high-risk nephrotic (MN with albumin < 2.0-2.5), vaccinations (pneumococcal); specific therapy tailored to GN (Ch339)。

339.4.2 💊 治療粟芁

  • supportive (all GN)ACE/ARB (reduce proteinuria + BP) + low-Na diet + diuretics (loop ± thiazide) + statins + anticoagulation if high-risk + vaccinations + avoid nephrotoxins
  • nephrotic anticoagulationMN with albumin < 2.0-2.5 g/dL → LMWH or DOAC; continue until proteinuria resolves (severe hypoalbuminemia ↑ thrombosis)
  • immunosuppression (specific to GN) in Ch339steroids, cyclophosphamide, rituximab, MMF, CNIs (tacrolimus, cyclosporine), eculizumab/ravulizumab (aHUS), belimumab (lupus), voclosporin (lupus), sparsentan (FSGS/IgA)
  • vaccinations critical (especially nephrotic — encapsulated organism risk)PCV20 + PPSV23, annual flu, COVID, RSV ≥ 60, hepatitis B

339.4.3 🎯 盧醫垫的考前提醒

  1. nephrotic syndrome 5 倧特埵proteinuria > 3.5 g/24h、hypoalbuminemia < 3.5 g/dL、edema、hyperlipidemia (↑ LDL + TG)、hypercoagulability (esp renal vein thrombosis from antithrombin III loss)
  2. nephritic syndrome 暙誌hematuria + RBC casts + dysmorphic RBC + HTN + AKI variable + edema + proteinuria variable (often sub-nephrotic)
  3. top nephrotic causesMCD (children 80%), FSGS (adults US), MN (older — anti-PLA2R 70-80% diagnostic), DKD (globally most), amyloid
  4. top nephritic causesIgA nephropathy (globally most), PSGN (kids), lupus nephritis (Class I-VI), ANCA (GPA/MPA/EGPA), anti-GBM (Goodpasture), MPGN/C3G
  5. RPGN 3 types (Couser)Type I anti-GBM、Type II immune complex (lupus, post-infectious, IgA)、Type III pauci-immune (ANCA); 郜有 crescents on biopsy
  6. renal biopsy is gold standardlight microscopy + immunofluorescence (pattern key) + electron microscopy (deposits + foot process effacement)
  7. anti-PLA2R primary MN 70-80%useful for diagnosis + monitoring + treatment response correlates with antibody decline
  8. C3 low diseases: PSGN, lupus nephritis, MPGN/C3G, cryoglobulinemia (Hep C) — important differential
  9. nephrotic anticoagulation indicationsMN with albumin < 2.0-2.5 g/dL → LMWH or DOAC; high renal vein thrombosis + DVT/PE risk
  10. vaccinations critical in nephrotic syndromeencapsulated organism risk (S. pneumoniae) → PCV20 + PPSV23flu + COVID + RSV + hep B