儿科学_第七版配套教材

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

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

3、nisabnormal,andmaypresentwithrenalhypertensionAGNRPGN●Thesuddenonset●mainlypresentwithhematuria,associatedwithproteinuriaofdifferentextent,somepatientsmayalsopresentwithedema,hypertensionandrenaldysfunction.●courseislessthan1year●Thesuddenonset●progressiverenaldy

4、sfunction.●progresstoend-stagerenalfailurewithinafewweeks,theoutcomeispoorAlportsyndrome●x-linkeddominantnephritis●associatedwithdeafness●thesplittingofGBM●NodefinitivetreatmentIgAnephropathy●theprevalenceishighinasia●therenalbiospyischaracterizedbymesangialproli

5、ferationunderlightmicroscopeandmesangialIgAdepositionbyimmunofluorescence●80-90%presentwithasymptomatichematuria1-3daysafteraURIorotherinfection,renalfunctionisnormal●mostchildrenrecoverorremainstable,however,30%ofpatientsdevelopprogressiverenaldiseaseandchronicr

6、enalfailureafter10-20yearsHaemolyticuraemicsyndrome(HUS)●microangiopathichaemolyticanaemia●acuterenalfailure●thrombocytopeniaNon-glomerular●polycysticdisease●infection●trauma●tumours(wilmstumour)●calculihaematological●coagulopathy(hemophilia)●thrombocytopenia(AA,

7、ITP)●renalveinthrombosisNon-haematological●exercise(oftenpresentwithmicroscopichematuria,andresolveafterafewdaysofrest)●drugs(cyclophosphamide)EvaluationofHematuria●history(precedinginfections,latentperoid,relationshiptoexercise,pasthistoryofhematuria,pastorrecen

8、thistoryofedema,familyhistoryofkinneystone,deafness.etc●physicalexamination(hypertension,edema,rash,abdominalmass,examinationofgenitalia,etc)●laboratorytests●u