课件：急性链球菌感染后肾小球肾炎.ppt

Acute Poststreptococcal Glomerulonephritis(APSGN) APSGN follows infection of the throat or skin by certain “nephritogenic” strains of group A β-hemolytic streptococci Throat (serotype 12) , cold weather months. skin (serotype 49) , warm weather months. Etiology * Diagrams depicting the ultrastructural features of a normal glomerular capillary loop (A) , and the ultrastructural features of APSGN (B), Note the subepithelial hump like dense deposits and endocapillary hypercellularity. Immune complexes antigens Activation of Compliments Recruitment of leukocytes GBM damage, Blood ingredients leakage Hematuria Proteinuria RBC Casts Proliferation of MC and EC Blockage of renal capillaries and decreased GFR Edema hypertention heart failure encephalopathy renal failure Oliguria, sodium and water retention, hypervolemia Inflammation mediates, Cytokines, proliferative F. Infection of streptocacci PATHOGENESIS Hematuria: Gross hematuria (30-50%), microscopic hematuria are more common. Edema(90%): typically presents in the face and upper extremities. Ascites and anasarca may occur in children. Hypertension(75% ): usually mild to moderate, and most evident at the onset of nephritis and typically subsides promptly after diuresis. Proteinuria: Many patients have significant proteinuria, but 5% of symptomatic patients develop frank nephrotic syndrome. Typical manifestations Laboratory Findings (1) Urinalysis Hematuria is nearly always present in APSGN. Other findings on microscopy are those of leukocytes, red blood cell casts, and granular casts. Macroscopic hematuria typically has a rusty or tea-color. Proteinuria is nearly always present but typically in the sub-nephrotic range. Nephrotic-range proteinuria occurs in 5% of patients. The urine contains large amounts of fibrin degradation products, and fibrinopeptides. Laboratory Findings (2) GFR and Blood chemistory The BUN concentration is elevated in 75% of patients, and serum creatinine level is increased in one half