肾炎肾病幻灯.ppt

Acute Glomerulonephritis Beijing Children’s Hospital affiliated to Capital University of Medical Sciences Meng Qun Acute Glomerulonephritis Definition Etiology and Pathogenesis Pathology Clinical features Laboratory findings Diagnosis and differential diagnosis Treatment Definition acute onset postinfectious glomerulonephritis: pharyngitis or pyoderma often belong to acute poststreptococcal glomerulonephritis(APSGN) result of inflammatory glomerular injury Definition hematuria proteinuria edema hypertension renal insufficiency  common age: 5~14y 2y:rare male/female≈2/1 self-limited prognosis:fine morbidity :on the decline  Etiology bacteria, viruses, mycoplasma … group A β-hemolytic streptococci type 12: pharyngitis types 2,49,50,55,60: pyoderma type 49: pharyngitis or pyoderma Pathogenesis secondary to a direct toxic effect on the glomerulus of a streptococcal protein the streptococcal product induce an immune complex-mediated injury 1)introducing an antigen to the glomrulus: planted antigen 2) deposition of circulating immune complexes 3) altering a normal renal antigen to a self-antigen inducing an autoimmune response to the self-antigen Pathology diffuse global hypercellularity proliferative mesangial and endothelial cells crescent formation subepithelial deposition interstitial edema interstitial infiltration of leukocyte Clinical features present from asymptomatic to oliguric acute renal failure latent period : after pharyngitis: 6~12 days after skin infection: 14~28 days Nonspecific symptoms and signs tiredness headache appetite slightly fever vomiting… the sign of infection Classical manifestation(1) hematuria gross hematuria: 50~70% patients coffee-colored or tea-colored turn to microhematuria: after 1~2w Classical manifestation(2) edema :70% patients reason: sodium and fluid retention presents: face periorbital