天津医科大学内科学课件 Acute glomerulonephritis.pptVIP

Acute glomerulonephritisChronic glomerulonephritis Han hong ling Filtration membrane Endothelial cell Capillary membrane Epithelial cell GBM barrier Size barrier Charge barrier The Glomerulopathiescomplex 1. acute glomerulonephritis (AGN); 2.rapidly progressive glomerulonephritis (RPGN); 3. nephrotic syndrome (NS); 4.chronic glomerulonephritis (CGN); 5.asymptomatic urinary abnormalities. class Acute glomerulonephritis(AGN) Poststreptococcal glomerulonephritis (PSGN) certain strains of the Group A streptococcus The antigen of streptococcus can be found in the mesangial and endothelial cells of proliferative glomeruli. Pathogenesis Uncertain immune complex disease Antigen may be derived from the group A streptococcal organism itself Pathology Light microscopy Renal biopsies performed early in the course reveal diffuse endocapillary proliferative glomerulonephritis. Pathology Immunoflurescence microscopy Clinical feature Latent period tonsillitis Hematuria Proteinuria Edema hypertension Oligoanuria Renal function lesion Others Laboratory findings 1 urine 4 to 6 months Red blood cell cast, leukocyte cast, FDP, C3 Non-selective proteinuria 2 Blood ASO CIC + mild anemia ESR c3 complication Heart failure Encephalopathy Acute renal failure Diagnosis AGN occur in a short time Latent period Evidence of streptococcal infection Renal biopsy (if necessary) Treatment Rest and food Edema Hypertension Infection No specific therapy supportive and symptomatic Prognosis Children epidemic good Adults sporadic less favorable RPGN reaches end stage renal failure within a period of days or weeks uremia Live on hemodialysis It can be an idiopathic primary glomerular disease or can be superimposed on other glomerular diseases, either primary or secondary. e.g SLE, IgA nephropathy.