儿科学 第七版配套教材.ppt

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1、HematuriaandglomerulonephritisXiangxiao,SongassistantSoochowuniversityaffiliatedchildrenhospitalNephrologydepartmentHematuriagrosshematuriamicroscopichematuria>5RBCs/HPFConceptofHematuriaCommonreasonsofHematuriaRenalcausesNon-renalcausesGlomerularNon-glomerularhaematologicalN

2、on-haematologicalGlomerular●Glomerulonephritis(AGN,CGN,RPGN)●Recurrenthematuria(Alportsyndrome,IgAnephropathy)●Haemolyticuraemicsyndrome(HUS)●Henoch-Schonleinpurpura(HSP)●Systemiclupuserythematosus(SLE)CGN●courseofdiseaseisover1year●Therenalfunctionisabnormal,andmaypresentwithr

3、enalhypertensionAGNRPGN●Thesuddenonset●mainlypresentwithhematuria,associatedwithproteinuriaofdifferentextent,somepatientsmayalsopresentwithedema,hypertensionandrenaldysfunction.●courseislessthan1year●Thesuddenonset●progressiverenaldysfunction.●progresstoend-stagerenalfailurewit

4、hinafewweeks,theoutcomeispoorAlportsyndrome●x-linkeddominantnephritis●associatedwithdeafness●thesplittingofGBM●NodefinitivetreatmentIgAnephropathy●theprevalenceishighinasia●therenalbiospyischaracterizedbymesangialproliferationunderlightmicroscopeandmesangialIgAdepositionbyimmun

5、ofluorescence●80-90%presentwithasymptomatichematuria1-3daysafteraURIorotherinfection,renalfunctionisnormal●mostchildrenrecoverorremainstable,however,30%ofpatientsdevelopprogressiverenaldiseaseandchronicrenalfailureafter10-20yearsHaemolyticuraemicsyndrome(HUS)●microangiopathicha

6、emolyticanaemia●acuterenalfailure●thrombocytopeniaNon-glomerular●polycysticdisease●infection●trauma●tumours(wilmstumour)●calculihaematological●coagulopathy(hemophilia)●thrombocytopenia(AA,ITP)●renalveinthrombosisNon-haematological●exercise(oftenpresentwithmicroscopichematuria,a

7、ndresolveafterafewdaysofrest)●drugs(cyclophosphamide)EvaluationofHematuria●history(precedinginfections,latentperoid,relationshiptoexercise,pasthistoryofhematuria,pastorrecenthistoryofedema,familyhistoryofkinneystone,deafness.etc●physicalexamination(hypertension,edema,rash,abdom

8、inalmass,examinationofgenitalia,etc)●laboratorytests●u