急性肾小球肾炎-的-20090212.pptVIP

毛建华 DEFINITION EPIDEMIOLOGY APSGN is a disease that affects primarily children, with the peak incidence being between ages of 2 and 6 years, Males are more likely than females to have overt nephritis. ETIOLOGY Nephritogenic strains of β–hemolytic streptococci PATHOGENESIS 1. Immune complex glomerulonephritis caused by deposition of circulating antigen-antibody complexes. 2. Autoimmune glomerulonephritis caused by deposited IgA being directed against a mesangial antigen or neo-antigen. 3. Immune complexes are formed in situ in the mesangium in response to a planted antigen. PATHOLOGY Endocapillary proliferative nephritis Classically: 1. Edema and oliguria 2. hematuria 3. hypertension In some patients 1. Hypervolemia 2. Encephalopathy 3. Oilguric acute renal failure LABORATORY FEATURE ■ Complement：C3, CH50 ■ Blood ■ Renal function examination ■ ESR ■ urinalysis ■ ASO, ADNase-B, Ahase, et al. Differential diagnosis Rapidly progressive glomerulonephritis Chronic glomerulonephritis Infection-associated glomerulonephritis not caused by streptococcus Secondary glomerulopathies PROGNOSIS Post-Streptococcal GN TREATMENT Treatment of acute PSGN is largely that of supportive care 1. Stay in Bed 1. Stay in Bed 2. DIET CONTROL 2. DIET CONTROL 3. ANTIBIOTICS 3. ANTIBIOTICS 4. Symptom control diuretics and anti-hypertension therapy 1. Congested circulation 2. Encephlopathy 3. Acute renal failure * * Acute Glomerular Nephritis Mao Jianhua, Department of Nephrology, The Children’s Hospital of Zhejiang University School of Medicine Light microscopy the glomeruli are found to be swollen and filled with cells obscuring much of the delicate network of the normal glomerular tugt. 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。 Immunofluores