北京医院-急性肾小球肾炎.ppt

2. Severe cases (3) Acute renal failure: Oliguria even anuria, azotemia, hyperkalemia metabolic acidosis Clinical manifestation Clinical manifestation 3.Atypical cases (1) Acute nephritis with minimal urinary findings The patient may have generalized edema, hypertension, even circulatory congestion, but no urinary abnormalities or minor abnormalities. Measurement of C3 and needle biopsy is needed for diagnosis. Clinical manifestation 3.Atypical cases (2) Acute nephritis with severe proteinuria: Apart from the characteristics of acute nephritis the patient has massive proteinuria. Clinical manifestation 3.Atypical cases (3)Asymptomatic acute nephritis (or subclinical form): the patient has mild abnormalities of urine, no other symptoms, measurement of C3 is helpful in diagnosis. Laboratory findings 1.Urinalysis: (1) Gross or microscopic hematuria: Urine appears reddish brown or smoky, RBC 3/HP , malformation RBC60%. (2) Proteinuria:1+ ~3+. (3) The urinary sediment: WBC and epithelial cells, hyaline, granular and red blood cell casts Laboratory findings 2.Blood test (1) a mild anemia (3) ESR: the erythrocyte sedimentation rate↑ (4) Hypocomplementemia: C3, CH50↓. Laboratory findings 2.Boold test (5) ASO: Antistreptolycin 0 titer elevated from 1 to 3 weeks after infection, the highest level from 3 to 5 weeks. Anti-DNAse B and anti hyaluronidase are elevated in patients with polyderma. (6) Renal function: SCr↑, BUN↑and GFR ↓due to severe oliguria. Pathology ? In gross observation the kidneys appear Symmetrically enlarged. ? By light microscopy --all glomeruli appear enlarged and relatively bloodless --show cells proliferation, such as epithelial cells, endothelial cells,mesangial cells. --polymorphonuclear leukocytes invade in glomeruli during the early stage of the disease,