肾炎肾病幻灯课件

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1、NicetomeetyouAcuteGlomerulonephritisBeijingChildren’sHospitalaffiliatedtoCapitalUniversityofMedicalSciencesMengQunAcuteGlomerulonephritisDefinitionEtiologyandPathogenesisPathologyClinicalfeaturesLaboratoryfindingsDiagnosisanddifferentialdiagnosisTreatme

2、ntDefinitionacuteonsetpostinfectiousglomerulonephritis:pharyngitisorpyodermaoftenbelongtoacutepoststreptococcalglomerulonephritis(APSGN)resultofinflammatoryglomerularinjuryDefinitionhematuriaproteinuriaedemahypertensionrenalinsufficiencycommonage:5~14y<

3、2y:raremale/female≈2/1self-limitedprognosis:finemorbidity:onthedeclineEtiologybacteria,viruses,mycoplasma…groupAβ-hemolyticstreptococcitype12:pharyngitistypes2,49,50,55,60:pyodermatype49:pharyngitisorpyodermaPathogenesissecondarytoadirecttoxiceffectonth

4、eglomerulusofastreptococcalproteinthestreptococcalproductinduceanimmunecomplex-mediatedinjury1)introducinganantigentotheglomrulus:plantedantigen2)depositionofcirculatingimmunecomplexes3)alteringanormalrenalantigentoaself-antigeninducinganautoimmunerespo

5、nsetotheself-antigenstreptococcalantigenCICinsituICtriggerautoimmunitycomplementactivitedinflammatoryglomerularinjuryGBMdamagedhematuriaproteinuriaproliferativemesangialandendothelialcellsGFRoliguria,edema,hypertentionPathologydiffuseglobalhypercellular

6、ityproliferativemesangialandendothelialcellscrescentformationsubepithelialdepositioninterstitialedemainterstitialinfiltrationofleukocyteClinicalfeaturespresentfromasymptomatictooliguricacuterenalfailurelatentperiod:afterpharyngitis:6~12daysafterskininfe

7、ction:14~28daysNonspecificsymptomsandsignstirednessheadacheappetiteslightlyfevervomiting…thesignofinfectionClassicalmanifestation(1)hematuriagrosshematuria:50~70%patientscoffee-coloredortea-coloredturntomicrohematuria:after1~2wClassicalmanifestation(2)e

8、dema:70%patientsreason:sodiumandfluidretentionpresents:faceperiorbitalupperextremitiesClassicalmanifestation(3)hypertention:30~80%patientsmildtomoderateschoolagepatients≥130/90mmHgpre-schoolagepatients≥120/80mmHgClassicalmanifest