肾病综合征患儿水肿发生机制及治疗

Etiology and treatment of edema in nephrotic syndrome

肾病综合征是儿科常见的肾小球疾病,水肿是肾病综合征患儿常见的重要体征,在一定程度上影响患儿的生活质量和疾病预后。肾病综合征水肿的发生可能存在多种机制,近代学者提出了“充盈过多”学说,即患儿存在肾脏“原发性”水钠潴留(与低白蛋白血症、肾素-血管紧张素-醛固酮系统无关)而导致血容量增加、水肿形成。肾病综合征患儿除积极治疗原发病外,水肿的对症处理主要包括低盐饮食、限制入量和利尿治疗,其关键在于判断水肿的程度和准确评估机体的血容量状态,从而采取不同的利尿方案。

Nephrotic syndrome is a common glomerular disease in children. Generalized edema is the most frequent sign of children with nephrotic syndrome, which affects their quality of life and prognosis. The mechanism of nephrotic edema remains controversial. Recent studies support the ＂overfill＂ hypothesis that primary intrarenal defect in sodium handling is responsible for edema. The treatment of edema includes restriction on salt and water intake and administration of diuretics. Different strategies should be employed based on the fine assessment of fluid status and severity of edema.