【Mayo疾病大全】肾病综合症

译者 明 ASAKURA

Definition

By Mayo Clinic staff

By Mayo Clinic staff

Nephrotic syndrome is a kidney disorder that causes your body to excrete too much protein in your urine.

【定义&概述】
    肾病综合症（NS）是一组以大量蛋白尿（尿中含有大量蛋白质）为基本特征的临床综合症。

Nephrotic syndrome is usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood. When healthy, these vessels keep blood protein from seeping into your urine and out of your body. When damaged, they don't perform this function effectively, and protein can leak out of your blood and lead to swelling all over your body (edema).

    肾病综合症一般是由肾小球（肾脏里面的小血管簇，可以滤过血液内的废物和多余水分）的损害引起的。健康的肾小球会阻止血液中的蛋白质漏进尿中、排出体外，但是当它受损时就失去了这种功能，使得血液中的蛋白质大量流失，并造成全身性的水肿。

Treatment for nephrotic syndrome includes treating the underlying condition that's causing it and taking medications. Nephrotic syndrome can increase your risk of infections and blood clots. Your doctor may recommend steps to prevent these and other complications of nephrotic syndrome.

    肾病综合症的治疗方法包括对因治疗和对症治疗(吃药)。医生还会推荐一些其他方法以预防（肾病综合症的）症状和其它并发症。

Symptoms

Signs and symptoms of nephrotic syndrome include:

【症状】   肾病综合症的症状和体征包括：

Swelling (edema), particularly around your eyes and in your ankles and feet

Foam in the toilet water, which may be caused by excess protein in your urine

Weight gain due to excess fluid retention

  水肿   尤以眼部周围和脚、踝为甚。
  泡沫样尿   这是因为尿中含有大量蛋白质（想想做饭时打鸡蛋）。
  体重增加   这是因为此时体内含有过量的体液（水纳潴留）。

When to see a doctor

 Make an appointment with your doctor if you have any signs or symptoms that worry you.

§ 何时看医生？

    当症状困扰你时，就去看医生。

Causes

Nephrotic syndrome is usually caused by damage to the clusters of tiny blood vessels (glomeruli) of your kidneys.

【病因】   如前所述，肾病综合症一般是由肾小球受损造成的。

The glomeruli filter your blood as it passes through your kidneys, separating things your body needs from those it doesn't. Healthy glomeruli keep blood protein (mainly albumin) — which is needed to maintain the right amount of fluid in your body — from seeping into your urine. When damaged, glomeruli allow too much blood protein to leave your body, leading to nephrotic syndrome.

    当血液流经肾脏时，肾小球便在不停地过滤着血液——它们把血液中有用的东东和无用的东东分开来。健康的肾小球会保留血液中的蛋白质（大部分是白蛋白）——后者肩负着维持适当体液总量的任务——而不会把它们随意扔进尿里。肾小球受损后，就挡不蛋白质的蜂拥而“出”，从而导致肾病综合症。

Many possible causes

Many diseases and conditions can cause glomerular damage and lead to nephrotic syndrome, including:

§ 一些可能的病因

    很多因素或疾病都可以损伤肾小球并引发肾病综合症，包括：

Minimal change disease. The most common cause of nephrotic syndrome in children, this disorder results in abnormal kidney function, but when the kidney tissue is examined under a microscope, it appears normal or nearly normal. The cause of the abnormal function typically can't be determined.

微小病变性肾病   这是儿童肾病综合症的最常见病因。此时肾功能出现异常，但光镜（光学显微镜）下并无明显的病变。病因常常不明。

Focal segmental glomerulosclerosis. Characterized by scattered scarring of some of the glomeruli, this condition may result from another disease or a genetic defect or occur for no known reason.

局灶节段性肾小球硬化   特征为散在的肾小球瘢痕化（上右图——系膜基质增多——译者注）。病因可能是别的疾病（比如高血压，或由上述微小病变性肾病演变而来）、基因缺陷、或其它未知原因。

Membranous nephropathy. This kidney disorder is the result of thickening membranes within the glomeruli. The exact cause of the thickening isn't known, but it's sometimes associated with other medical conditions, such as hepatitis B, malaria, lupus and cancer.

膜性肾病   特征是肾小球基底膜（上左图——基膜）的增厚。病因不明，但患者往往伴随其他疾病，如乙肝、疟疾、狼疮、癌症等。

Diabetic kidney disease. Diabetes can lead to kidney damage (diabetic nephropathy) that affects the glomeruli.

糖尿病(性)肾病   糖尿病会对肾脏造成损害，从而影响肾小球功能。

Systemic lupus erythematosus. This chronic inflammatory disease can lead to serious kidney damage.

系统性红斑狼疮   这种慢性炎性疾病会严重损害肾功能。

Amyloidosis. This disorder occurs when substances called amyloid proteins accumulate in your organs. Amyloid buildup often affects the kidneys, damaging their filtering system.

(肾)淀粉样变性   这是一种全身性疾病，此时淀粉样物质在身体器官内沉积。沉积在肾脏，则损害滤过系统。

Blood clot in a kidney vein. Renal vein thrombosis, which occurs when a blood clot blocks a vein connected to the kidney, can cause nephrotic syndrome.

肾静脉血块   肾脏静脉中的血凝块会促使血栓形成，进而引起肾病综合症。

Heart failure. Some forms of heart failure, such as constrictive pericarditis and severe right heart failure, can cause nephrotic syndrome.

心衰   某些类型的心衰（如缩窄性心包炎、或严重的右心衰）会引发肾病综合症。

Risk factors

Factors that can increase your risk of nephrotic syndrome include:

【危险因素】  下面这些因素可能增加患肾病综合症的风险：

Medical conditions that can damage your kidneys. Certain diseases and conditions increase your risk of developing nephrotic syndrome, such as diabetes, lupus, amyloidosis, minimal change disease and other kidney diseases.

对肾脏有损害的疾病状况   比如糖尿病、狼疮、淀粉样变、一些肾脏病（比如微小病变性肾病）等等。

Certain medications. Examples of medications that can cause nephrotic syndrome include nonsteroidal anti-inflammatory drugs and drugs used to fight infections.

某些药物   比如非甾体抗炎药(NSAIDs)和消炎药。

Certain infections. Examples of infections that increase the risk of nephrotic syndrome include HIV, hepatitis B, hepatitis C and malaria.

某些感染   比如艾滋病、乙肝、丙肝、疟疾等。

Complications

Possible complications of nephrotic syndrome include:

【并发症】   可能的并发症包括：

Blood clots. The inability of the glomeruli to filter blood properly can lead to loss of blood proteins that help prevent clotting. This increases your risk of developing a blood clot (thrombus) in your veins.

血凝块   肾小球滤过功能的异常会导致血液中对抗凝血的蛋白质的丢失——这样你的静脉中就容易产生血栓。

High blood cholesterol and elevated blood triglycerides. When the level of the protein albumin in your blood falls, your liver makes more albumin. At the same time, your liver releases more cholesterol and triglycerides.

高脂血症   如前所述，此时血液中的白蛋白减少，所以肝脏会比以往合成更多的白蛋白——这个过程中，肝脏会向血液中释放更多胆固醇和甘油三酯，从而使它们在血液中的含量增高。

Poor nutrition. Loss of too much blood protein can result in malnutrition. This can lead to weight loss, but it may be masked by swelling.

营养不良   血液中蛋白质丢失过多会造成营养不良，但它可能会被水肿症状掩盖。（想想非洲那些吃不上饭的穷孩子）

High blood pressure. Damage to your glomeruli and the resulting buildup of wastes in your bloodstream (uremia) can raise your blood pressure.

高血压  肾小球损害会使代谢废物在血液中累积（尿毒症）并使血压上升。

Acute kidney failure. If your kidneys lose their ability to filter blood due to damage to the glomeruli, waste products may build up quickly in your blood. If this happens, you may need emergency dialysis — an artificial means of removing extra fluids and waste from your blood — typically with an artificial kidney machine (dialyzer).

急性肾衰(竭)   此时肾脏的滤过功能急剧下降，使得血液内代谢废物快速增加。这类病人需要通过透析机进行急诊透析——一种用于清除血液中的废物和多余水分的人工方法。

Chronic kidney failure. Nephrotic syndrome may cause your kidneys to gradually lose their function over time. If kidney function falls low enough, you may require dialysis or a kidney transplant.

慢性肾衰(竭)   肾病综合症会使肾脏逐渐失去它的功能，达到一定程度时病人就需要透析或是肾移植。

Infections. People with nephrotic syndrome have an increased risk of infections.

感染   肾病综合症会增加患传染性疾病的风险。

Preparing for your appointment

You're likely to start by first seeing your family doctor or a general practitioner. If your doctor suspects you may have a kidney problem, such as nephrotic syndrome, you may be referred to a doctor who specializes in the kidneys (nephrologist).

【看病前的准备】  首先你可能会去看家庭医生或全科医生。如果他/她怀疑你有肾脏疾病（比如肾病综合症），你可能就得去泌尿科门诊看看了。

 Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

    因为就诊时间有限，而且有很多相关事情都需要考虑，你最好提早进行一些准备，包括：

Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

Write down key personal information, including any major stresses or recent life changes.

Make a list of all medications, as well as any vitamins or supplements, that you're taking.

Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.

     ● 提前做好检查时需要的限制。预约就诊时，问好你需要提前做的事情，比如限食。

      ● 写下所有你感觉到的症状，哪怕你觉得它无关紧要。

     ● 写下重要的个人信息，包括目前你所面临的主要压力，和近期的生活变化。

     ● 写下所有你在服用的药品、维生素、补品。

     ● 如果可能，带着家人或朋友一起去。你自己可能难以完全理解并记下医生告诉你的事情。

Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For nephrotic syndrome, some basic questions to ask your doctor include:

§ 写下你想问医生的问题。
     和家庭医生或全科医生交流的时间有限，预备一个问题清单会帮助你有效利用这段时间。把问题按照重要性排列，以免时间不够。关于肾病综合症，一般你需要问：

What is likely causing my nephrotic syndrome?

What tests will I need?

Is my condition likely temporary or chronic?

Can my nephrotic syndrome be cured?

What are my treatment options?

What are the risks and benefits of each treatment?

Is there one treatment that you think is best for me?

Are there changes I can make to my diet to help me feel better?

Should I meet with a dietitian to learn more about changing my diet?

I have these other health conditions. How can I best manage them together?

Are there any restrictions that I need to follow?

Should I see a specialist? What will that cost, and will my insurance cover it?

Is there a generic alternative to the medicine you're prescribing me?

Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions at any time that you don't understand something.

● 我（的肾病综合症）最可能的病因是什么？
● 我还需要做哪些检查？
● 我的情况会是暂时性的还是慢性的？能够治愈吗？
● 我的治疗方案都有哪些选择？每种疗法的受益和风险是什么？对我而言哪种是最好的？
● 我需要做哪些饮食上的改变？需要咨询营养学家吗？
● 我还有其他健康问题。如何兼顾？
● 有什么限制或禁忌吗？
● 我该去医院门诊看吗？那样会花费多少，医保管吗？
● 药物有其他类别的选择吗？
● 有没有指南之类我可以带回家的东东？有推荐给我看的网站吗？
● 什么情况下我应该计划接受随访？

    有问题就问，不要犹豫。

Tests and diagnosis

Tests and procedures used to diagnose nephrotic syndrome include:

【检查与诊断】  肾病综合症的检查方法包括：

Urine tests. A urinalysis can reveal abnormalities in your urine, such as large amounts of protein, if you have nephrotic syndrome. You may be asked to collect urine samples over 24 hours for an accurate measure of the protein in your urine.

尿检   尿检会发现尿液中的异常，比如肾病综合症时的大量蛋白质。有时你可能会需要收集24小时内的全部尿液以便对其中的蛋白质含量进行精确的测量。

Blood tests. If you have nephrotic syndrome, a blood test may show low levels of the protein albumin (hypoalbuminemia) specifically and decreased levels of blood protein overall. Loss of blood protein may cause an increase in blood cholesterol and blood triglycerides. Serum creatinine and blood urea also may be measured to assess your overall kidney function.

验血   肾病综合症时，验血结果可能会提示：低白蛋白血症及低蛋白血症、高胆固醇血症、高甘油三酯血症等。血清肌酐和尿素水平也可以用来评估肾功能。

Removing a sample of kidney tissue for testing. Your doctor may recommend a procedure called a kidney biopsy to remove a small sample of kidney tissue for testing. During a kidney biopsy, a special needle is inserted through your skin and into your kidney. Kidney tissue is collected and sent to a laboratory for testing.

肾活检   用一种特殊的针头穿过皮肤进入肾脏并取下一小块组织样品，并送往实验室进行各种检验。

Treatments and drugs

Treatment for nephrotic syndrome involves treating the underlying medical condition that's causing your nephrotic syndrome.

【治疗和药物】  肾病综合症的治疗方法包括：

Your doctor may also recommend medications that may help control your signs and symptoms or treat complications of nephrotic syndrome. Medications may include:

    1. 治疗原发病（即引起肾病综合症的病因）。

    2. 药物对症治疗。比如：

Blood pressure medications. Drugs called angiotensin-converting enzyme inhibitors reduce blood pressure and also reduce the amount of protein released in urine. Medications in this category include benazepril (Lotensin), captopril (Capoten) and enalapril (Vasotec). Another group of drugs that works in a similar way is called angiotensin II receptor blockers and includes losartan (Cozaar) and valsartan (Diovan).

血压控制药物   血管紧张素转化酶抑制剂（ACEI）可以降低血压，并减少蛋白质从尿中的排泄。这类药物包括贝那普利（洛汀新）、卡托普利（开博通）、依那普利等。另一类作用类似的药物叫做血管紧张素Ⅱ受体拮抗剂 ，包括洛沙坦（科素亚）、缬沙坦（代文）等等。

Water pills. Water pills (diuretics) help control swelling by increasing your kidneys' fluid output. Diuretic medications include chlorothiazide, hydrochlorothiazide, furosemide (Lasix) or spironolactone (Aldactone).

利尿药   它们会通过增加排尿而改善水肿症状。包括氯噻嗪、氢氯噻嗪（双氢克尿塞）、呋塞米（速尿）、螺内酯（安体舒通）等等。

Cholesterol-reducing medications. Medications called statins can help lower cholesterol levels. Statins include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).

降脂药   他汀类药物会降低血液胆固醇水平。包括阿伐他汀（立普妥）、氟伐地汀（来适可）、洛伐它丁、普伐他丁（普拉固）、罗苏伐他汀、辛伐他汀等等。

Blood thinners. Medications called anticoagulants help decrease your blood's ability to clot and reduce your risk of developing blood clots. Anticoagulants include heparin or warfarin (Coumadin).

血液稀释剂   抗凝剂可以降低产生血凝块的危险。包括肝素、华法林（香豆素）。

Immune-system-suppressing medications. Medications to control the immune system, such as corticosteroids, may decrease the inflammation that accompanies kidney disorders, such as membranous nephropathy.

免疫抑制剂   糖皮质激素和细胞毒类药物可以控制免疫系统，并减少可以并发肾病（比如膜性肾病）的炎症反应。

Antibiotics. Antibiotics can help control infections caused by bacteria.

抗生素   可以减少细菌感染。

Lifestyle and home remedies

Changes to your diet may help you cope with nephrotic syndrome. Your doctor may refer you to a dietitian to discuss how what you eat can help you cope with the complications of nephrotic syndrome. A dietitian may recommend that you:

【生活方式与家庭疗法】
      做一些饮食上的改变会帮助你面对肾病综合症。医生可能会为你推荐一位营养学家，后者会建议你：

Reduce the amount of fat and cholesterol in your diet to help control your blood cholesterol levels.

Eat a low-salt diet to help control the swelling (edema) you experience.

Increase the amount of calcium you eat each day since many people with nephrotic syndrome have low calcium levels.

    ● 减少食物中脂肪和胆固醇的摄入。
    ● 减少食盐摄入：可以改善水肿症状。
    ● 增加钙的摄入。

祝健康！