〖医学〗肾小球疾病二教材-课件.ppt

3.Nephritis syndrome (1)hematuria 100%，40% are gross hematuria (2)proteinuria frequent，20% are nephrotic syndrome (3)edema 90% (4)hypertension 80% (5)renal failure mild,acute renal failure 4.Laboratory findings acute phase of infection of Strep. elevated ASO titer (some Strep. No hemolysin O) only the marker of infection, not nephritis (2) acute phase of immune reactions serum C3 total complements?,return to normal within 8w blood CIC? Natural History edema and hypertension disappear in one month hematuria, proteinuria usually reduce in one month, resolve within 2 to 3 months some resolve within 6 to 12 months C3 return to normal in two months Diagnosis Points preliminary infection latent period acute onset surely hematuria, frequently edema and hypertension ASO ?, C3 ? —— dynamic change Self-limitation Differential Diagnosis Diseases presented with acute nephritis syndrome GN secondary to infection of other pathogens other bacteria, viruses (Varicella-zoster virus, EB, influenza virus) Climax of infection or within 5 days Mild abnormal of urine examination Hypertension and edema are unusual Normal blood complement level rapidly progressive GN CGN systemic diseases lupus nephritis Sch?nlein-Henoch purpura Indications of kidney biopsy Oligouria 1w，except ECBV insufficient, urinary tract obstruction, etc Progressive renal failure Unresolved in 2 months untypical manifestation, or with nephrotic syndrome Treatment 1.Supportive treatment Rest Food water Restrictive intake of NaCl 5 g/d if moderate to severe edema or hypertension Water if decreased urine volume Protein Renal failure, but not dialysis yet 2.Treatment of infection Penicilin for 2 w Tonsillectomy– if recurrent attacks of tonsillitis patient’s condition is stable, Upro1g/d, URBC 10/HP Penicilin for 2 wks before and after the surgery 3. Symptomatic treatment Diuresis Antihypertension Dialysis Prognosis hematuria,