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一组不同病因的急性肾小球肾炎acutenephriticsyndrome.AcutepoststreptococcalNon-poststreptococcalIncidenceage:in5~14yearspeakage:3~7yearsBoys>girls=Incidencepeak:Jan.Feb.Sep.andOct.Etiology&GroupAβ-hemolyticstreptococci(20%)Pococci,Viral:influenza,mumps,Coxsackie,ECHOandEBVOtherpathogens:fungiEtiologyEtiology&免疫复合物→肾小球毛细血管炎致肾炎菌株（nephritogenic——致肾炎抗原Etiology& In EtiologyEtiology&→depositedonglomerular→complementsystemactivated→immunemediatorsandinflammatory主要的病变＊肾小球弥漫性、增生性炎＊早期有渗andmesangialcells）增生，炎性细免疫荧光检毛细血管袢和系膜区颗粒状IgG&C3沉Electron★Hump-like（驼峰样electrondensedeposits（电子致密物InfectionofImmuneLocalimmuneinflammationinglomerularcapillariesStenosisofblood Glomerularfiltration membraneinjury BloodSodiumandwater Circulatoryload↑Clinical轻重不前 :呼吸道和皮咽炎，咽峡炎，皮 等Incubationperiodabout7-12daysforpharyngitis,14~20daysforskininfectionClinicalClinicalOrdinarysymptoms:lowgradefever,nausea,debility,malaise,anorexiaandvomiting,epistaxisClinical1.2Principalsymptoms(nephricsigns)Edema(nonpitingedema,nephriticEdemaisthemostcommoninitialsign—periorbitaledemaOliguriamaybeClinicalMicroscopic~(mostofGross~(1/3~1/2cases):usuallyteaorcolacolored(brownish)urine,continue1~2w血尿血尿ClinicalHypertension:1/3~2/3casesPre-schoolage>120/80mmHgSchoolage>130/90mmHgHeadachemaybepresentProteinuria 提示系膜增生较严Clinical严重表现Severefindings起病 出现以下严重症状ClinicalSeriousCirculatoryRR↑,HR↑,fidget,→→dyspnea,jugularphlebe pulmonaryedema,galloprhythmandcardiacdilation（肺血管充血ClinicalClinical透性↑→脑水肿Smartheadache,nausea,anddiplopiaortransientblindness,coma,convulsionClinicalClinicalAcuterenalSevereoliguriaoranuria→temporaryazotemia,disturbanceofelectrolytesandmetabolicacidosisClinical型表现(Atypical▲Extrarenalsymptomatic▲Acutenephritiswithnephrotic▲AsymptomaticLaboratoryLaboratoryRoutineurinalysisRBC↑,2+~3+,>5/hpf,Protein1+~3+,Mayoccurhyaline(orgranularorredcell)+/-LaboratoryLaboratoryBloodHemogram:initialmildanemia,WBC↑ornormalRenalfunctions:BUNandCrarenormalorslightincreaseLaboratoryImmunologic链球 后10~14天开始升高 期3~5周，3~6个月恢复正常LaboratoryLaboratoryADNase-B:positiverateishigh(morethan90%cases)LaboratoryLaboratorySerum80%~90%cases—lowCH50 andlowC3(within2woftheonset),normalizedin6~8wIfC3stilllowafter8w→otherCourse&▲病程About2▲ :4~6周恢复正▲ESR:2~3个月恢复正Course&▲Addiscount:4~8▲Microscopichematuriamaypersistfor6m~1y▲Prognosis:mostchildren(95%)haveacompleterecover,recurrencesareClinicaldiagnosisAcuteNephritic*Prodromal*Evidenceofstreptococcal*LowDifferential其它病原 所慢性肾炎急性发急进性肾小球肾继发性肾炎PurpuricnephritisThereisnospecifictreatmentfortypicalcases.GeneralFrequentmeasurementofRestBedrest:within2wofSlightactivities:edemasubsided,BPbenormalandgrosshematuriaContinuetoattendschool:ESRreturnstonormalNormalactivities:3mafterroutineurinetestbe★Edema,hypertension:restrictsodium–lowsa iet(sodiumchloride60mg/kg/d),orsalt-freediet★Azotemia:proteins0.5★Severeoliguria,BP↑orcirculatorycongestion:Restrictfluidintake,charttorecordintakeandObject:toeradicateremnantbacteriainthefocuses,butdoesnotalternaturalhistoryofAGN.Penicillin:im,for10~14Symptomatic（DHCT）1~2mg/kg/d分次2~5mg/kg/d,分次Antihypertensive 0.2~0.3(Max1mg/kg/d分2~3次，口服或舌★Captopril0.3~0.5mg/kg/d,(Max5~6mg/kg/d)分2~3次口服DealwithseriousHypertensive硝普钠5~10mg+10%GS100ml(50~100ug/ml),1ug/kg/min,≯8ug/kg/min注意监测血止痉：首Ser