26 .肾小球疾病-八年制课件.pptVIP

HE 。 PAS 。 IgA 。 。 The Patient Has IgA nephropathy! 。 IgA Nephropathy Most common GN Mesangioproliferative or other pathological types Predominent mesangial IgA deposit Persistent or episode of hematuria Exacerbate on infection 1/3 have elevated serum IgA 。 Clinical syndromes of glomerular diseases Asymptomatic hematuria/ or proteinuria Nephrotic syndrome Acute glomerular nephritis Rapidly progressive glomerular nephritis Chronic glomerular nephritis 。 Nephrotic Syndrome Insidious onset Manifestations Proteinuria 3.5g/d Hypoalbuminemia alb 30 g/l Edema Hyperlipidemia 。 Nephrotic syndrom-etiology(1) Primary Nephrotic syndrom  minimal change disease FSGS membranous nephropathy membranoproliferative GN IgAN 。 Nephrotic syndrom-etiology(2) Secondary Nephrotic syndrom Autoimmunity:SLE, Infection: Hepatitis B or C,HIV Tumor: solid carcinoma, lymphoma Metabolic: DM, Amyloidosis Drugs: NSAIDS 。 Nephrotic syndrom-epidemiology Children Yong people Old people Primary MCD FSGS,MsGN MN MPGN Secondary HSP SLE DN Hepatitis B HSP Tumor Inherited NS Hepatitis B MM , AL 。 14 year-old, male, high-school student History: No significant medical history Fatigue x 3 weeks Edema x 1 week Physical: Mild generalized edema Urinalysis: 4? protein Many hyaline casts Few granular casts No RBCs or RBC casts Lab Data: proteinuria 4g/d , alb 20g/l,normal renal function, Hepatitis (-), Auto-immunity Ab (-) Renal biopsy CASE II 。 The patient has Minimal change disease! 。 。 Electron Microscopy: effacement of foot processes 。 Incidence: Etiology: Clinical Features: Clinical Course: Loss of net negative charge on capillary basement membrane. Nephrotic syndrome. Prominent proteinuria edema No hypertension Sens