急性肾小球肾炎(全英班)课件

1、Acute Glomerulonephritis Pediatric dept of TCM hospital of Guangdong Province ContentFamiliar with EpidemiologyFamiliar with DiagnosisMaster Differentiation of syndrome and treatment Description of ancient doctor of TCM灵枢肿胀篇: Shuizhong in TCM (edema) start from eyelid,mild eyelid edema as if one jus

2、t get up,rapid pulse in neck, intermittent cough,cold feeling between perineum and thigh, edema in anterior tibial site and feet,enlarged abdomen,nopitting as if water in it.Description of western medicine EdemaHypertensionhematuriaDefinition of AGNAcute onset A disorder of a group of glomeruli due

3、to different causes Clinical manifestation: hematuria,edema,proteinuria,hypertensionEpidemiology of AGNAcute on set Prevail in children in 3-12,especialy in school age population,seldom seen in children below 2.Morbidity ratio of M:F is 1.52.5:1Pathogenesis of AGN in western medicineGroup A -hemolyt

4、ic streptococci EtiologyEtiology and Pathogenesis of AGN in western medicine Medical history： upper respiratory tract infection：12weeks before，winter and spring； skin infection ：23 weeks before,summer and autumPathogenesis Inflammation of kidney due to circulation immune complexes Pathology of AGNAG

5、N PATHOLOGY PASM-HE染色 400 正常 PASM染色 100 ECPGN Etiology of AGN in TCMSummaryExogenous ：wind /dampness /sore infection Internal ：congenital weak physique / acquired weak constitutionPathogenic factorQuestions Metabolism of water in TCMOppinion :Tree abundunce and two insufficiency Pathogenesis of AGN

6、in TCMPathogenesisETIOGYDredge water passageTransportation/distribution waterTransformation of qiWater metabolismWater and dampnessaccumulated in the skin and muscleGiving rise to edemaLUNGSPLEENKIDNEYClinical manifestation Medical history Streptococccal infection 1-3 weeks before onsetClinical mani

7、festationSymptoms and signs EdemaunpittingFace and eyelid Clinical manifestationSymptoms and signsOliguria year normal oliguria anuria1 400-500 200 1-3 500-600 200 30-50 4-6 600-800 300 7-14 800-1400 120/80 Early school 130/90（1）30%-80% cases。（2）resolves within 1-2 weeks accopany with increasing of

8、amount of urine（3）if very high，be careful of encephalic diseaseClinical manifestation Red blood cell +Red cast Proteinuria +， Routine urine examination Laboratory examinationClinical manifestation C3Laboratory examination 8090%，Serum C decrease within 2 weeks . recovery after 6-8 weeks Cdeterminatio

9、n is very important to differentiate between AGN and other types Severe condition acute congestive heart failure hypertensive encephalic disease acute kidney failure early stag（ in 2 weeks） Emergency，need rescueEssentials for dignosis Medical history: streptococcal infection like URI or skin infecti

10、on with in 1-3 weeksClinical manifestation: edema,oliguria,hematuria, hypertensionLab ：C3 decrease , ASO increaseSyndrome differentiation and treatment Sthenia , Eliminating first Common syndromes Wind and water struggling with each otherInternal invasion of dampness Qi deficiency of lung and spleen

11、 supplementary explanation: the first two syndromes can be seen at the early stage of AGN, while qi deficiency of lung and spleen can be seen at the late stage.Deteriorate syndrome Water and qi disturbing the heart and lungPathogenic factors invading JueyinInternal obstruction of water and toxin sup

12、plementary explanation: can be seen at the early stage Common syndromesWind and water struggling with each otherMain symptoms and signs : sudden onset edema:limbs and eyelids lustrous skin,unpitting edema, dark and scanty urine fever,aversion to cold cough whitish and thin fur floating/ tight or rap

13、id pusleTherapeutic methods :Dispelling wind and inducing diuresisPrescription and drugs:Modified mahuangLiaoqiao chixiaodoudecocotionInternal invasion of dampness and heatMain symptoms and signs : sudden onset edema:limbs and body , dark and scanty urine skin sore,fever,thirst,dysphoria chest distr

14、ess,thoracic fullness poor appetite,nausea red tongue,yellow and thin fur slippery and rapid pusleTherapeutic methods :Clearing away heat and Moving toxin,removing dampness to relieve edemaPrescription and drugs:Sanmiao pill in combination with daochi powerQi deficiency of the lung and spleenMain sy

15、mptoms and signs : be seen in late stage inapparent edema or no, disappearance of hematuria profuse sweat lustreless or pale complexion lassitude,hypodynamia pale tongue with whitish fur slow and weak pusleTherapeutic methods :Strengthening the spleen Supplementing qiPrescription and drugs:Modified

16、shenling baizhu powerIn combination with yupinfen powerWater and qi superiorly disturbing the heartMain symptoms and signs : be seen in early stage edema:limbs and body , cough with short breath, palpitation,chest distress cyanotic lips ,dysphoria inability to lie flat whitish and greasy fur rapid p

17、usle without forceTherapeutic methods :Purging the lung and expelling water,warming yang and enhence body resistancePrescription and drugs:Modified jijiao lihuang pillPathogenic factors invading jueyin meridianMain symptoms and signs : be seen in early stage headache,vertigo blur vision,dysphoria ac

18、cidental syncope clonic convulsion red tongue,yellow and rough fur taut pusleTherapeutic methods :Clearing away heat Calming the liverSuppressing yang Purging fire and heatPrescription and drugs:Modified longdan xiegandecoctionInternal stagnation of water and toxinMain symptoms and signs : be seen in early stage general edema , scanty urine or anuria dizziness,headache, nausea,vomiting,even coma greasy fur and taut pusle Therapeutic methods :Expelling the exterior pathogenic factors with pungent drugs and clearing the interior heat with bitter drugs so as to remove filt