肾病综合征（nephrotic syndrome，NS）简称肾综，是由多种病因引起，而以肾小球基膜通透性增加且伴有肾小球滤过率降低等病变为主的一组综合征；属一种肾脏功能异常的表现。
肾病综合征导致：蛋白质透过尿液流失（大量蛋白尿，>3.5g/d）、血液中白蛋白浓度过低（低白蛋白血症，<30g/L）、严重水肿、血液中脂肪浓度过高（高脂血症）等四种临床表现，其中前二者为主要诊断依据，后二者并非在所有患者身上表现。
Nephrotic syndrome (NS), referred to as nephrotic syndrome, is a group of syndromes caused by a variety of causes and mainly characterized by increased glomerular basement membrane permeability and reduced glomerular filtration rate ; It is a manifestation of abnormal kidney function.
Nephrotic syndrome causes: protein loss through urine (massive proteinuria, >3.5g/d), low albumin concentration in the blood (hypoalbuminemia, <30g/L), severe edema, fat concentration in the blood There are four clinical manifestations such as hyperlipidemia (hyperlipidemia), among which the first two are the main diagnostic basis, and the latter two are not manifested in all patients.
肾病综合征 是一种严重且令人衰弱的肾脏疾病，每年影响英国约 10,000 人，其中许多患者是幼儿。
Nephrotic syndrome is a serious and debilitating kidney condition that affects around 10,000 people in the UK each year – and many of these sufferers are young children.
肾病综合征若发生在儿童时期，若给予适当治疗并不会带来生命危险，但某些时候却可能引发成人慢性肾衰竭，或意味著某些严重疾病的前兆，如红斑性狼疮。
If nephrotic syndrome occurs in childhood, it will not be life-threatening if properly treated. However, sometimes it may cause chronic renal failure in adults or be a precursor to some serious diseases, such as lupus erythematosus.
病因
迄今为止肾病综合征的原因仍不完全明确，遗传、免疫、感染、药物及环境等诸多因素都可能参与其中。
发病因素
肾病综合征通常是由肾小球损伤引起的。当血液通过肾脏时，肾小球会过滤血液，将身体需要的东西与不需要的东西分开。
健康的肾小球能维持体内所需蛋白质含量，当肾小球受损时，将允许过多的血液蛋白质渗入尿液，导致肾病综合征。
1.免疫因素
免疫因素在原发性和继发性肾小球疾病中都十分重要。免疫复合物的形成可损伤肾小球滤过屏障，导致出现大量的蛋白尿。
Cause
The cause of nephrotic syndrome is still not completely clear so far, and many factors such as genetics, immunity, infection, drugs and environment may be involved.
Pathogenesis factors
Nephrotic syndrome is usually caused by glomerular damage. As blood passes through the kidneys, the glomeruli filter the blood, separating what the body needs from what it doesn’t.
Healthy glomeruli can maintain the required protein levels in the body. When glomeruli are damaged, too much blood protein will be allowed to leak into the urine, leading to nephrotic syndrome.
1.Immune factors
Immune factors are important in both primary and secondary glomerular diseases. The formation of immune complexes can damage the glomerular filtration barrier, leading to massive proteinuria.
2.遗传因素
近年来对遗传性因素的研究进展很快，确认了部分致病基因，这些基因的缺陷可导致肾病综合征的发生。
3.诱发因素
1）药物因素
药物和肾脏疾病的关系非常密切，有较多药物可以引起肾脏损伤，常见的有抗生素、非甾体类抗炎药、降压药、抗癌药及抗风湿药物等。药物性肾病综合征主要是膜性肾病，停药后大多能缓解。
2）感染
由病毒引起的肾病越来越多，主要有乙肝病毒、丙肝病毒、HIV病毒等，主要引起局灶节段性肾小球硬化。
2. Genetic factors
In recent years, research on genetic factors has progressed rapidly, and some pathogenic genes have been identified. Defects in these genes can lead to the occurrence of nephrotic syndrome.
3. Predisposing factors
1) Drug factors
The relationship between drugs and kidney disease is very close. There are many drugs that can cause kidney damage. Common ones include antibiotics, non-steroidal anti-inflammatory drugs, antihypertensive drugs, anti-cancer drugs and anti-rheumatic drugs. Drug-induced nephrotic syndrome is mainly membranous nephropathy, which can mostly be relieved after stopping the drug.
2) Infection
There are more and more kidney diseases caused by viruses, mainly hepatitis B virus, hepatitis C virus, HIV virus, etc., which mainly cause focal segmental glomerulosclerosis.
症状
肾病综合征的典型症状为“三高一低”，即大量蛋白尿、高度水肿、高脂血症和低蛋白血症，以及其他代谢紊乱和伴随症状等。
典型症状
1.大量蛋白尿
大量蛋白尿是最主要的临床表现，也是肾病综合征最基本的病理生理机制，是指成人每天尿蛋白排出量大于3.5g。早期一般不易发现，往往发展到水肿，患者才去就诊。也有部分患者可表现为尿中泡沫增多，高血压、高蛋白饮食或大量输注血浆蛋白可加重尿蛋白的症状。
2.低蛋白血症
指血浆白蛋白降至＜30g/L。大量白蛋白从尿中丢失，容易发生感染、微量元素缺乏、内分泌紊乱和免疫功能低下等并发症。
Symptom
The typical symptoms of nephrotic syndrome are “three highs and one low”, namely massive proteinuria, high degree of edema, hyperlipidemia and hypoalbuminemia, as well as other metabolic disorders and accompanying symptoms.
Typical symptoms
1. Massive proteinuria
Massive proteinuria is the most important clinical manifestation and the most basic pathophysiological mechanism of nephrotic syndrome. It refers to the daily urinary protein excretion of adults greater than 3.5g. It is generally not easy to detect in the early stage, and it often develops into edema before the patient goes to see a doctor. Some patients may also experience increased foam in the urine. High blood pressure, high protein diet, or large amounts of plasma protein infusion can aggravate the symptoms of proteinuria.
2. Hypoalbuminemia
Refers to plasma albumin falling to <30g/L. A large amount of albumin is lost in the urine, which is prone to complications such as infection, trace element deficiency, endocrine disorders, and low immune function.
3.水肿及体重增加
水肿和体重增加是早期的典型症状，水肿初期表现为晨起时眼睑水肿，晚间有下肢和脚踝水肿。低白蛋白血症使血管内液体在组织间隙积聚，是造成水肿的基本原因。
4.高脂血症
一般情况下，胆固醇升高最早出现，随后出现高甘油三酯血症，以及血清中低密度、极低密度脂蛋白水平增加。高脂血症可增加心血管并发症的危险性。
伴随症状
5.血压变化
肾病综合征患者血压常偏离正常范围，高血压是常见的伴随症状之一。而在部分儿童患者中，血压常常偏低，严重者甚至会导致休克。
3. Edema and weight gain
Edema and weight gain are typical early symptoms. The initial symptoms of edema are eyelid edema in the morning and lower limbs and ankle edema in the evening. Hypoalbuminemia causes intravascular fluid to accumulate in the interstitial space, which is the basic cause of edema.
4. Hyperlipidemia
Typically, elevated cholesterol appears first, followed by hypertriglyceridemia and increased serum levels of low-density and very-low-density lipoproteins. Hyperlipidemia increases the risk of cardiovascular complications.
accompanying symptoms
5. Blood pressure changes
The blood pressure of patients with nephrotic syndrome often deviates from the normal range, and hypertension is one of the common accompanying symptoms. In some children, blood pressure is often low, and in severe cases, it can even lead to shock.
6.其他症状
早期症状还包括食欲不振、全身不适、发热无力、肌肉萎缩等。这些症状因为缺乏特异性而很难引起患者重视。
诊断标准
医生会根据患者的年龄、发病情况、病程特征、临床症状和辅助检查结果综合分析做出诊断。以下四个条件中，前两项为确诊是否患有肾病综合征的必要条件。
1.尿蛋白大于3.5g/d；
2.血浆白蛋白低于30g/L；
3.水肿；
4.高脂血症。
6. Other symptoms
Early symptoms also include loss of appetite, general malaise, fever and weakness, muscle atrophy, etc. These symptoms are difficult for patients to pay attention to because they lack specificity.
Diagnostic criteria
Doctors will make a diagnosis based on a comprehensive analysis of the patient’s age, onset, course characteristics, clinical symptoms and auxiliary examination results. Among the following four conditions, the first two are necessary to confirm whether you have nephrotic syndrome.
1. Urinary protein is greater than 3.5g/d;
2. Plasma albumin is lower than 30g/L;
3. Edema;
4. Hyperlipidemia.
相关检查
通过检测尿液中蛋白的存在以及尿沉渣镜检，可以初步判断是否有肾小球病变。检查时留尿注意留取中段尿。
- 24小时尿蛋白定量
肾病综合征患者24小时尿蛋白定量超过3.5g是诊断的必备条件。
3.血液生化测定
包括血浆蛋白测定、血脂测定等，血浆白蛋白低于30g/L是诊断的必备条件；还可出现白蛋白与球蛋白比例倒置，血胆固醇显著增高，脂质代谢紊乱等。
抽血检查前注意空腹，不可进食及饮水，以免影响检查结果。
4.凝血功能检查
包括凝血指标，如凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原等，以判断血凝、血栓及栓塞情况。抽血检查前不可进食及饮水，以免影响检查结果。
Related inspections
1. Urine routine
By detecting the presence of protein in urine and microscopic examination of urine sediment, we can initially determine whether there is glomerular disease. During the examination, be sure to collect mid-section urine.
2. 24-hour urine protein quantification
In patients with nephrotic syndrome, a 24-hour urine protein quantity exceeding 3.5g is a necessary condition for diagnosis.
3. Blood biochemistry testing
Including plasma protein measurement, blood lipid measurement, etc. Plasma albumin lower than 30g/L is a necessary condition for diagnosis; the ratio of albumin to globulin can also be inverted, blood cholesterol is significantly increased, and lipid metabolism is disordered.
Before taking the blood test, be sure to have an empty stomach and refrain from eating or drinking to avoid affecting the test results.
4. Coagulation function test
Including coagulation indicators, such as prothrombin time, activated partial thromboplastin time, fibrinogen, etc., to determine blood coagulation, thrombus and embolism. Do not eat or drink before the blood test to avoid affecting the test results.
5.肾功能测定
检测尿素氮、肌酐等指标，用来进一步了解肾脏功能是否受损及其损伤程度，可指导制定治疗方案，并评估恢复情况。
6. 肾活检
取患者的小块肾组织样本进行检测，为有创检查。
7.其他检查
应根据不同病因有选择性的进行实验室检查，如血糖、尿糖的检查，乙肝丙肝指标的检查，红斑狼疮的检查等，以便对原发病的病因进行诊断。
5. Renal function measurement
Detection of urea nitrogen, creatinine and other indicators can be used to further understand whether kidney function is damaged and the degree of damage, which can guide the formulation of treatment plans and evaluate recovery.
6. Kidney biopsy
A small piece of kidney tissue sample is taken from the patient for testing, which is an invasive test.
7.Other inspections
Laboratory tests should be carried out selectively according to different causes, such as blood sugar and urine sugar tests, hepatitis B and C index tests, lupus erythematosus tests, etc., in order to diagnose the cause of the primary disease.
鉴别诊断
慢性肾衰的终末期即尿毒症，是指各种慢性肾脏病持续进展至后期的共同结局，最终导致肾脏功能渐进性减退，直至功能丧失。一般表现为代谢产物潴留，水、电解质及酸碱平衡失调等症状，常发生于慢性肾功能不全多年的患者中。
2. 肾炎综合征
以肾小球源性血尿为主要特征，常伴有蛋白尿，可有水肿、高血压或肾功能损害。多见于免疫力低下的青年人或老年人。
3. 出血热
出血热又称肾综合征出血热，是由流行性出血热病毒（汉坦病毒）引起，鼠类为主要传染源。以发热、出血、充血、低血压休克及肾脏损害为主要临床表现，多见于青壮年人群。
Differential diagnosis
1. Uremia
The end stage of chronic renal failure, namely uremia, refers to the common outcome of various chronic kidney diseases that continue to progress to the later stage, eventually leading to a gradual decline in kidney function until the function is lost. It generally manifests as metabolite retention, water, electrolyte and acid-base balance disorders, etc. It often occurs in patients with chronic renal insufficiency for many years.
2. Nephritic syndrome
The main feature is glomerular hematuria, often accompanied by proteinuria, and may include edema, hypertension or renal damage. It is more common in young people or the elderly with low immunity.
3. Hemorrhagic fever
Hemorrhagic fever, also known as hemorrhagic fever with renal syndrome, is caused by epidemic hemorrhagic fever virus (hantavirus), and rats are the main source of infection. The main clinical manifestations are fever, bleeding, congestion, hypotensive shock and kidney damage, which are more common in young and middle-aged people.
4. 慢性肾炎
慢性肾炎是由于长期肾脏疾病病情迁延并呈缓慢进展，造成不同程度肾功能损害，最终发展为慢性肾衰竭。基本临床表现为蛋白尿、血尿、高血压、水肿，多见于患有长期肾小球疾病的中青年人群中。
4. Chronic nephritis
Chronic nephritis is due to the persistence and slow progression of long-term kidney disease, causing varying degrees of renal function damage and eventually developing into chronic renal failure. The basic clinical manifestations are proteinuria, hematuria, hypertension, and edema, which are more common in young and middle-aged people with long-term glomerular disease.
西医治疗
患者在患病期间应注意休息，避免到公共场所以预防感染，饮食上要注意摄入适量的优质蛋白、足够的热量、低盐低油脂。在药物选择上，糖皮质激素和细胞毒性药物是主要治疗药物。
1.一般治疗
1）休息与活动
凡有严重水肿、低蛋白血症者需卧床休息。水肿消失、一般情况好转后，可起床活动。
Western medicine treatment
Patients should pay attention to rest during the illness, avoid going to public places to prevent infection, and pay attention to the intake of appropriate amounts of high-quality protein, sufficient calories, and low salt and fat in their diet. In terms of drug selection, glucocorticoids and cytotoxic drugs are the main treatment drugs.
1.General treatment
1) Rest and activities
Those with severe edema and hypoalbuminemia need bed rest. After the edema disappears and the general condition improves, you can get up and move around.
2）饮食治疗
给予正常量的优质蛋白（0.8~1.0g/（kg·d），以富含必需氨基酸的动物蛋白为主）；
保持充足的热量，每日不应少于126~147kJ/kg；
由于高蛋白饮食增加肾小球高滤过，加重蛋白尿并促进肾脏病变进展，故不主张患者高蛋白饮食；
出现水肿表现时应使用低盐（＜3g/d）饮食；
为减轻高脂血症，应少吃含油脂的食物，而多吃富含多聚不饱和脂肪酸（如植物油、鱼油），及富含可溶性纤维（如燕麦、米糠等）的食物。
2) Diet therapy
Give a normal amount of high-quality protein (0.8~1.0g/(kg·d), mainly animal protein rich in essential amino acids);
Maintain sufficient calories, which should not be less than 126~147kJ/kg per day;
Because a high-protein diet increases glomerular hyperfiltration, aggravates proteinuria, and promotes the progression of kidney disease, patients are not advised to eat a high-protein diet;
When edema occurs, a low-salt (<3g/d) diet should be used;
To reduce hyperlipidemia, you should eat less fatty foods and more foods rich in polyunsaturated fatty acids (such as vegetable oil, fish oil) and soluble fiber (such as oats, rice bran, etc.).
2.对症治疗
1） 利尿消肿
应用袢利尿剂、噻嗪类利尿剂和潴钾利尿剂等，通过增加肾脏的液体输出来利尿并减轻水肿。使用过程中要注意不宜过快过猛，以免造成血容量不足。同时监测血液中电解质含量，防止其他并发症的产生。
2）减少尿蛋白及降血压
某些降血压药物，如血管紧张素转化酶抑制剂或血管紧张素受体拮抗剂，除可有效控制高血压外，还可以减少尿中蛋白质的释放量。应用时所用剂量一般应比常规降压剂量大，才能获得良好疗效，须在医生的指导下使用。
2. Symptomatic treatment
1) Diuresis and swelling
Loop diuretics, thiazide diuretics, and potassium-sparing diuretics are used to diuretic and reduce edema by increasing the fluid output of the kidneys. During use, be careful not to use it too fast or too hard to avoid insufficient blood volume. At the same time, monitor the electrolyte content in the blood to prevent other complications.
2) Reduce urinary protein and lower blood pressure
Certain blood pressure-lowering drugs, such as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, in addition to being effective in controlling high blood pressure, can also reduce the amount of protein released in the urine. The dosage used during application should generally be larger than the conventional antihypertensive dosage in order to obtain good curative effect, and must be used under the guidance of a doctor.
3）降血脂治疗
一般而言，存在高脂血症的肾病综合征患者因其发生心血管疾病的风险增高，可考虑给予降脂药物治疗，如他汀类药物，可以有效控制血脂，治疗高脂血症。
药物治疗。
4）糖皮质激素
糖皮质激素主要起到抗炎作用，减轻急性炎症时的渗出，是主要的治疗药物。
常用药物为泼尼松，使用原则和方案：起始足量、缓慢减药、长期维持。水肿严重、有肝功能损害或泼尼松疗效不佳时，可更换为泼尼松龙口服或静脉滴注。
3) Lipid-lowering treatment
Generally speaking, patients with nephrotic syndrome who have hyperlipidemia have an increased risk of cardiovascular disease and may be given lipid-lowering drugs, such as statins, which can effectively control blood lipids and treat hyperlipidemia.
Medication.
4) Glucocorticoids
Glucocorticoids mainly play an anti-inflammatory role and reduce exudation during acute inflammation, and are the main therapeutic drugs.
The commonly used drug is prednisone, and the usage principles and protocols are: adequate dosage at the beginning, slow dosage reduction, and long-term maintenance. When edema is severe, liver function is damaged, or prednisone is ineffective, oral or intravenous infusion of prednisolone can be used.
中医
肾病综合征属于中医的“水肿”、“血尿”、“腰痛”、“虚劳”等范畴医`学教育网搜集整理。
病因病机
中医认为，本病外因有风、湿、热、毒、劳欲等。内因主要与肺、脾、肾及三焦等脏腑输布水精的功能失调所致。 Traditional Chinese Medicine
Nephrotic syndrome belongs to the categories of “edema”, “hematuria”, “low back pain” and “consumption” of traditional Chinese medicine, collected and compiled by the Medical Education Network.
Cause and pathogenesis
Traditional Chinese medicine believes that the external causes of this disease include wind, dampness, heat, poison, fatigue, etc. The internal cause is mainly caused by the dysfunction of the lungs, spleen, kidneys, triple burners and other internal organs.
水肿的基本病理为：其标在肺，其制在脾，其本在肾。若外邪袭肺，肺失宣肃，不能通调水道；或脾不健运，水谷不化，水湿内停；或肾气不足，开合失司，均可导致水肿。若水湿泛溢，阻遏阳气；或其人素体阳虚者，可见脾肾阳虚。若水肿日久，内耗阴血，可见肝肾阴虚。若水病及血，久病入络，又可见瘀水互结之证。若病变累及多脏腑者，往往阴阳不相恋，以致元阳衰败，真阴耗竭，浊毒内盛，则病情危笃。
The basic pathology of edema is: its mark is in the lungs, its control is in the spleen, and its origin is in the kidneys. If external evil attacks the lungs, the lungs lose their circulation and can’t regulate the water passages; or the spleen does not move well, the water and grains cannot be melted, and the water and dampness stop inside; or the kidney qi is insufficient and the opening and closing of the lungs are not able to open and close, all of which can lead to edema. If water and dampness overflow, blocking Yang Qi; or if the person’s body is Yang deficiency, it can be seen that the spleen and kidney Yang are deficient. If edema lasts for a long time and internal consumption of yin and blood occurs, liver and kidney yin deficiency can be seen. If water disease involves blood and long-term disease enters the collaterals, symptoms of blood stasis and water intertwining may also be seen. If the disease involves multiple internal organs, yin and yang often do not match each other, leading to the decline of primary yang, depletion of true yin, and excessive accumulation of turbid toxins, resulting in a critical condition.
诊断要点
1.明显水肿。
2.尿常规及24小时尿蛋白 尿蛋白定性多十十十～十十十十；定量＞3.5克/24小时；Ⅱ型肾病综合征还可发现血尿或镜下红细胞（尿沉渣镜检＞10个红细胞/高倍视野）。
3.血浆蛋白 极大部分呈现低白蛋白血症。
4.血脂 血浆胆固醇、甘油三酯（三酰甘油）均明显增加；低密度及极低密度脂蛋白浓度增加；高密度脂蛋白正常或稍下降。
5.肾功能 肾功能多数正常；但肾病综合征Ⅱ型常可出现不同程度的肾功能损害，表现为内生肌酐清除值下降；甚而血肌酐、尿素氮增高。 Diagnostic points
1. Obvious edema.
2. Urine routine and 24-hour urine proteinuria qualitatively show more than ten ten to ten ten ten ten; quantitatively >3.5 g/24 hours; type II nephrotic syndrome can also reveal hematuria or microscopic red blood cells (urine sediment microscopy >10 red blood cells/high power field).
3. Plasma protein: most cases show hypoalbuminemia.
4. Blood lipids: Plasma cholesterol and triglycerides (triacylglycerols) increased significantly; low-density and very low-density lipoprotein concentrations increased; high-density lipoproteins were normal or slightly decreased.
5. Renal function: Most renal functions are normal; however, nephrotic syndrome type II often causes varying degrees of renal function damage, manifested as a decrease in endogenous creatinine clearance; or even an increase in serum creatinine and urea nitrogen.
6.血清补体C3测定对膜增殖性病变的鉴别有意义。
7.病理诊断 主要病理类型有微小病变、系膜增殖、膜性、局灶节段性硬化、膜增殖性等。
6. Serum complement C3 measurement is meaningful for the identification of membrane proliferative lesions.
7. Pathological diagnosis: The main pathological types include minimal change disease, mesangial proliferation, membranous disease, focal segmental sclerosis, membranoproliferative disease, etc.
辩证分型
1.风水泛滥型：眼睑及面部浮肿，以后迅速波及全身，肢体酸楚困重，小便不利；可兼有恶风，鼻塞，咳嗽。苔薄白，脉浮而紧，也可兼咽部红肿疼痛。
征候分析：风邪外袭，其性轻扬，与水湿相搏，则眼睑及面部浮肿、以后迅速波及全身；风邪袭肺，肺失宣肃，不能通调水道，下输膀胱，则肢体酸楚困重、小便不利；偏风寒者，可有恶风寒、鼻塞、咳嗽、苔薄白、脉浮而紧；偏风热者，则见咽部红肿疼痛、舌红、苔黄、脉浮数。
Dialectical classification
1. Excessive Feng Shui type: swelling of the eyelids and face, which quickly spreads to the whole body, soreness and pain in the limbs, and difficulty in urination; it may also be accompanied by bad wind, nasal congestion, and cough. The coating is thin and white, the pulse is floating and tight, and the throat may be red, swollen and painful.
Symptom analysis: When wind evil attacks externally, its nature is light, and when it fights with water and dampness, the eyelids and face will be swollen, which will quickly spread to the whole body; wind evil attacks the lungs, and the lungs will not be able to clear up the water, and the water channels will be lost, and the limbs will be swollen. Aches and pains, severe sleepiness, and difficulty in urination; those with wind-cold symptoms may have aversion to wind-cold, stuffy nose, cough, thin white coating, and floating and tight pulse; those with wind-heat symptoms may have red, swollen and painful throat, red tongue, yellow coating, and floating pulse .
2.湿邪化热型：全身浮肿，皮色光亮绷急，口渴烦热，胸腹痞满，尿赤，便秘，或皮肤有疮痍。舌红，苔黄腻，脉滑数。
证候分析：水湿之邪，郁而化热，壅于肌肤，故有全身浮肿、皮色光亮绷急；湿热弥漫三焦，气机升降失常，则胸腹痞满；湿热壅滞，津液不上承，则口渴烦热；热邪偏重，则便秘、尿赤；湿热化毒外发，而见皮肤有疮痍；舌红、苔黄腻、脉滑数为湿热内蕴之象。
2. Damp pathogen -transforming heat type: edema all over the body, bright and tense skin, thirst and heat, fullness in the chest and abdomen, red urine, constipation, or skin sores. Red tongue, yellow and greasy coating, slippery and rapid pulse.
Syndrome analysis: Water-dampness evil causes stagnation and turns into heat, which is blocked in the skin, so there is edema all over the body, bright skin and tightness; dampness and heat permeate the triple burner, and abnormal rise and fall of Qi, resulting in fullness in the chest and abdomen; dampness and heat stagnation , if body fluids are not maintained, there will be thirst and irritability; if the heat evil is severe, constipation and red urine will occur; dampness and heat will transform toxins externally, and skin sores will be seen; red tongue, yellow and greasy coating, and slippery pulse are signs of internal dampness and heat. .
3.肾元亏虚型：浮肿较轻，或晨起面浮，傍晚跗肿，腰膝酸软，乏力困倦。舌淡红，苔薄白或白腻，脉沉细。
证候分析：肾者主水，肾虚水气不化，停聚于内，故浮肿较轻、或晨起面浮、傍晚跗肿；腰为肾之府，肾虚，则腰膝酸软；肾之精气不足，故乏力困倦；舌淡红、苔薄白或白腻、脉沉细为肾气亏虚、水湿停滞之象。
4.水瘀互结症状：面浮肢肿反复发作，渐见肌肤甲错，面色黧黑，红丝赤缕，瘀点瘀斑，或兼腰痛尿赤。舌淡或黯红，舌边有瘀点，舌下筋系瘀紫，苔薄黄或腻，脉细涩。
3. Kidney deficiency type: mild edema, or facial bloating in the morning, swollen hocks in the evening, soreness and weakness in the waist and knees, fatigue and drowsiness. The tongue is light red, the fur is thin and white or greasy, and the pulse is deep and thready.
Syndrome analysis: The kidney governs water. If the kidney is deficient, the water qi will not be transformed and will stop gathering inside, so the edema will be mild, or the face will be floating in the morning and the tarsus will be swollen in the evening. The waist is the home of the kidney. If the kidney is deficient, the waist and knees will be sore and weak. Insufficient essence and qi lead to fatigue and drowsiness; a pale red tongue, thin white or greasy coating, and a heavy and thready pulse are symptoms of kidney qi deficiency and water-dampness stagnation.
4. Symptoms of water stasis and blood stasis: recurrent facial swelling and swelling of the limbs, gradual appearance of skin onychomycosis, dark complexion, red threads, petechiae and petechiae, or low back pain and red urine. The tongue is pale or dark red, with petechiae on the edges of the tongue, purple stasis on the tendons under the tongue, thin yellow or greasy fur, and a thready and astringent pulse.
证候分析：水湿与瘀血互结，泛滥肌肤，故面浮肢肿；瘀血阻滞，血行不畅，不能外荣，则见肌肤甲错、面色黧黑、红丝赤缕、瘀点瘀斑；瘀血留滞于内，血液不循经而行，不通则腰痛尿赤；舌淡或黯红、舌边有瘀点、舌下筋系瘀紫、苔薄黄或腻、脉细涩是为水瘀互结之象。
Syndrome analysis: water-dampness and blood stasis combine together and flood the skin, resulting in a floating face and swollen limbs; blood stasis is blocked, the blood circulation is not smooth, and the blood cannot flow outwards, and the skin is stained, the complexion is dark, red threads, and petechiae are seen. petechiae ; Blood stasis stays in the body, blood does not flow along the menstrual flow, and blockage results in low back pain and red urine; pale or dark red tongue, petechiae on the edges of the tongue, purple blood stasis on the sublingual tendons, thin yellow or greasy coating, and thready and astringent pulse. It is a sign of water and blood stasis intertwined.
5.脾肾阳虚型：周身俱肿，按之没指，甚者可伴胸腹水，气急胸闷，大便溏薄，小便短少，形寒肢冷，面色？白。舌谈体胖，苔薄或腻，脉沉细。
证候分析：水湿不化，开阖失司，水液不得正常运行排出而停于体内，溢于肌肤，故见周身俱肿、按之没指、甚者可有胸腹水出现；湿浊上泛，气机不利，故气急胸闷；脾虚运化无权，故大便搪薄；阳不化气，而小便短少；阳气亏虚，失于温煦，故面色白、形寒肢冷；舌谈体胖、苔薄或腻、脉沉细为脾肾阳虚，水湿内壅之象。
5. Spleen and kidney yang deficiency type: swelling all over the body, no finger when pressed, and in severe cases, it may be accompanied by pleural and abdominal effusion, shortness of breath, chest tightness, loose stools, short urine, cold body and cold limbs, and complexion? s white. The tongue is fat, the coating is thin or greasy, and the pulse is heavy and thready.
Syndrome analysis: Water and dampness cannot be melted, and the opening and closing of the joints are lost. The water cannot be discharged normally and stops in the body, overflowing on the skin. Therefore, the whole body is swollen, and there is no finger when pressing. In severe cases, there may be effusion in the chest and abdomen; dampness turbidity Upper pancreas means poor Qi movement, resulting in shortness of breath and tightness in the chest; spleen deficiency has no power to transport and transform, so the stool is thin; Yang does not transform Qi, and the urine is short; Yang Qi is deficient and loses warmth, so the complexion is? White skin, cold appearance, cold limbs; fat tongue, thin or greasy coating, and heavy and thready pulse are signs of spleen and kidney yang deficiency and water-damp internal congestion.
6.肝肾阴亏型：浮肿反复不甚，头晕目眩，烦热口渴，咽喉肿痛，情绪急躁，盗汗，腰酸尿赤。舌红，脉细弦数。
证候分析：肝肾阴虚，水湿留滞不去，故浮肿反复不甚；阴虚内热，故口渴、咽喉肿痛；阴虚阳亢，则头晕目眩；虚热上扰心神测情绪急躁；肾虚则腰酸；阴虚内热，则盗汗、烦热；湿热下注，故尿赤；舌红、脉细弦数为肝肾阴虚之象。
6. Liver and kidney yin deficiency type: recurring mild edema, dizziness, irritability and thirst, sore throat, irritability, night sweats, soreness in the waist and red urine. Red tongue, thin and stringy pulse.
Syndrome analysis: Liver and kidney yin deficiency, water and dampness remain, so edema recurs; Yin deficiency and internal heat lead to thirst, sore throat; yin deficiency and yang hyperactivity lead to dizziness; deficiency and heat disturb the mind and mood. Irritability; kidney deficiency leads to backache; yin deficiency and internal heat lead to night sweats and irritability; dampness and heat cause red urine; red tongue, thin and stringy pulse are signs of liver and kidney yin deficiency.
7.阴阳衰竭型：眼睑虚浮，乏力倦怠，面色萎黄，语音低怯，胸腹胀满，呕恶纳呆，口中有尿臭，或小便短少，或夜尿频多，甚者则昏愦、瘙痒、抽搐、黑粪。舌淡，苔腻腐，脉细滑无力。
证候分析：湿浊留恋化毒，气血大伤，阴阳衰竭，故见眼睑虚浮、乏力倦怠、面色萎黄、语音低怯；浊毒不降，气机不畅，故胸腹胀满；湿浊上泛，则呕恶纳呆、口中有尿臭；阴阳衰竭，故小便短少、或夜尿频多；元神虚衰，故昏愦；血行不畅，筋脉肌肤失养，故见瘙痒、抽搐；藏统失司，血不循经，故有黑粪；舌淡、苔腻腐、脉细滑无力为阴阳衰竭、浊毒内盛之象。
7. Yin and yang failure type: puffy eyelids, fatigue and tiredness, sallow complexion, low voice, fullness in the chest and abdomen, vomiting and indigestion, smelly urine in the mouth, or short urination, or frequent nocturia, or even dizziness, itching, Convulsions, melena. Pale tongue, greasy and rotten coating, thin and slippery pulse.
Syndrome analysis: Dampness and turbidity linger to transform into toxins, qi and blood are severely damaged, and yin and yang are exhausted, so you can see puffy eyelids, fatigue and tiredness, sallow complexion, and low voice; turbidity and poisoning do not subside, and the qi movement is not smooth, so the chest and abdomen are distended; dampness and turbidity If the upper level is general, there will be vomiting, nausea, indigestion, and smelly urine in the mouth; Yin and Yang will be exhausted. , so the urine is short or frequent at night; the spirit is weak, so it is dizzy; the blood flow is not smooth, the muscles and skin are not nourished, so itching and twitching are seen; the Tibetan system is lost, and the blood does not circulate through the meridians, so there is black stool; A pale tongue, greasy and rotten coating, and a thready and slippery pulse are signs of Yin and Yang failure and excessive turbidity and poison.
1.患者应注意休息，预防感染，水肿期应服用无盐饮食。
2.食用西瓜、冬瓜、赤豆、绿豆、薏苡仁、玉米等具有利水作用的食品。忌食虾、蟹等海腥发物及烟酒等刺激之品。水肿消退期可改为低盐饮食，其他禁忌食物也可适当少量食用，并且根据病情的程度适当进食一些蛋白质、维生素丰富的食物，如鸡、鸭、鲫鱼、瘦肉等，但不可过量。
3.了解肾病综合征的病理类型，对治疗及预后有积极意义。如微小病变以儿童多见，预后好。膜性在成年人多见，预后略差。
Things to note
1. Patients should pay attention to rest to prevent infection, and should take a salt-free diet during the edema period.
2. Eat watermelon, winter melon, adzuki beans, mung beans, coix kernels, corn and other foods with diuretic effects. Avoid eating fishy fishy products such as shrimps and crabs, as well as stimulating products such as tobacco and alcohol. During the edema subsidence period, you can switch to a low-salt diet, and other taboo foods can also be eaten in small amounts. Depending on the severity of the condition, you can also eat some protein- and vitamin-rich foods, such as chicken, duck, crucian carp, lean meat, etc., but not in excess.
3. Understanding the pathological types of nephrotic syndrome has positive significance for treatment and prognosis. For example, minimal lesions are more common in children and the prognosis is good. Membranous disease is more common in adults and has a slightly worse prognosis.
（作者简介： 张恩勤教授，英国中医学院院长，英国皇家医学会和英国中医药学会资深会员）