儿科学 第七版配套教材分析.pptVIP

Hematuria and glomerulonephritis Xiang xiao ,Song assistant Soochow university affiliated children hospital Nephrology department 1、Severe circulation congestion: usually happen within the frist week,due to the output of fluid decrease,present with tachypnea, dyspnea,cough,etc， moist rales in the lung, severe edema,heart and liver may enlarge . 2、hypertensive encephalopathy: BP 140/90mmHg, present with convulsion ,coma, etc，the older may complain headache,vomit and temporary blind. 3、acute renal failure: oliguria,even anuria,renal dysfuction,usually last for 3-5 days, minority keep on over 10 days grave manifestation Usually take place in the frist 2 weeks laboratory tests ● urinalysis: hematuria and proteinuria ● blood test:C3 ↓ ASO(antistreptolysin O)↑ ● kidney biopsy: not necessary normal C3 ASO 1 2 3 4 5 6 7 8 time (weeks) 16 ASO: begin to raise in the 10-14th day,climb to the peak in 3-5th week,and recover normal in 3-6th month C3: decrese within 2weeks after the onset of disease and recover normal within 8 weeks diagnosis of AGN diagnosis 1、Preceding infection(the latent period of 1-3 weeks) 2、 Clinical manifestation（acute onset, oliguria, edema, hematuria ,proteinuria，hypertension ） 3、C3↓, ASO↑ differential diagnosis 1、 Postinfectious AGN 2、IgA nephropathy 3、acute episode of CGN 4、nephrotic syndrome 5、RPGN 6、HSPN, LPN Treatment 1、essential supportive treatment 2、symptomatic treatment 3、clear residual streptococcus 4、treatment of severe case essential supportive treatment ●rest (especially wthin the frist 2 weeks) ●appropriate fluid and salt restriction diuretics(furosemide, 1-2mg/kg.time) hypotensive drugs(nifedipine, 0.25-1mg/kg.day) symptomatic treatment Hematuria ? gross hematuria ? microscopic hematuria 5 RBCs /HPF Concept of Hematuria Common reasons of Hematuria Renal causes Non-renal causes Glomerular Non-glomerul