急性肾小球肾炎-最新的-20090212课件

AcuteGlomerularNephritisMaoJianhua,DepartmentofNephrology,TheChildren’sHospitalofZhejiangUniversitySchoolofMedicine11/26/20221毛建华DEFINITION11/26/20222毛建华EPIDEMIOLOGYAPSGNisadiseasethataffectsprimarilychildren,withthepeakincidencebeingbetweenagesof2and6years,Malesaremorelikelythanfemalestohaveovertnephritis.11/26/20223毛建华11/26/20225毛建华11/26/20226毛建华11/26/20227毛建华11/26/20228毛建华11/26/202210毛建华11/26/202212毛建华11/26/202214毛建华PATHOLOGY

Endocapillaryproliferativenephritis11/26/202215毛建华Lightmicroscopytheglomeruliarefoundtobeswollenandfilledwithcellsobscuringmuchofthedelicatenetworkofthenormalglomerulartugt.11/26/202216毛建华11/26/202217毛建华正常肾小球，用PAS染色以突出基底膜。肾小球血管袢薄而清晰。11/26/202218毛建华11/26/202220毛建华ImmunofluorescencemicroscopyGlomerulardepositsofIgGandC3incapillaryandmesangium11/26/202221毛建华11/26/202223毛建华11/26/202224毛建华11/26/202226毛建华11/26/202227毛建华ClinicalFeatures11/26/202228毛建华11/26/202230毛建华11/26/202231毛建华11/26/202232毛建华Insomepatients

1.Hypervolemia2.Encephalopathy3.Oilguricacuterenalfailure

11/26/202233毛建华LABORATORYFEATURE

■Complement：C3,CH50■Blood■Renalfunctionexamination■ESR■urinalysis■ASO,ADNase-B,Ahase,etal.11/26/202234毛建华DifferentialdiagnosisRapidlyprogressiveglomerulonephritis

ChronicglomerulonephritisInfection-associatedglomerulonephritisnotcausedbystreptococcusSecondaryglomerulopathies11/26/202235毛建华

TREATMENT

11/26/202236毛建华TreatmentofacutePSGNislargelythatofsupportivecare11/26/202237毛建华1.StayinBed1.StayinBed11/26/202238毛建华2.DIETCONTROL2.DIETCONTROL11/26/202239毛建华3.ANTIBIOTICS3.ANTIBIOTICS11/26/202240毛建华4.Symptomcontroldiureticsandanti-hypertensiontherapy11/26/202241毛建华1.Congestedcirculation2.Encephlopathy3.Acuterenalfailure11/26/202242毛建华PROGNOSIS

11/26/202243毛建华Mostchildren(upto95%)fullyrecoverfromAPSGNinamatterofweeksormonths.Inthosewhodonotrecoverfully,chronicorprogressiveproblemsofkidneyfunctionmayoccur.Kidneyfailuremayresultinsomepatients.11/26/202244毛建华11/26/202245毛建华AcutePost-StreptococcalGNSynonyms:Incidence:Etiology:Clinical:Lab:Path:ClinicalCourse:Acuteproliferativeglomerulonephritis,acutepost-infectiousGN.Glomerulartrappingofcirculatinganti-streptococcalimmunecomplexes.GroupA,B-hemolyticstreptococci,type12.Acutenephriticsyndromepost-streptpharyngitisorpyoderma.Otherinfections.NephriticurinewithRBCcasts.Evidenceofstreptococcalinfectionorserologicevidenceofrecentinfection.Decreasedserumcomplement.Children-Excellentprognosis.Adults-Worseprognosis,somedevelopprogressivedisease.Enlarged,hypercellularglomeruliwithendothelialandmesangialcellproliferation.Acuteinflammation.IgGandC3inverycoarselygranularpatternalongGBMs.Discrete,subepithelial“hump-like”deposits.Peakincidenceinchildren(3-14).Sporatic,mostlywinterandspr