内科学教学课件：Glomerular Disease.pptVIP

Clinical presentations Hypertension Salt and water retention volume overload Hyperreninemic states(RAAS actiation) Exogenous erythropoietin administration Decrease of antihypertension substance HBP Clinical presentations Renal insufficiency ---Different degree Serum creatinine ↑ Ccr↓ eGFR ↓ Urine volume abnormal Chronic progression of the disease is associated with: Histologic type Therapy condition. The exist of worsening factors: tiredness, infection, uncontrolled hypertension, nephrotoxic drugs. Diagnosis and differential diagnosis Diagnosis: Clinical manifestation： proteinuia, hematuria, edema, hypertension, renal insufficiency. Secondary and hereditary glomerulonephritis should be excluded. Course3 M, most onset hidden ,complication B ultrasound :bilateral small kidney 2. Differential diagnosis Secondary GN: lupus nephritis, anaphylactoid purprua. Alport syndrome commonly seen in children（ 10ys）abnormality of renal, eyes and ears exist simultaneously. A positive family history is found. Other primary glomerulonephritis Acute GN post infection: mainly seen in children prodromal symptom: 1-3 weeks before hematuria: almost 100% serum C3 , yet recover to normal level within 8 weeks. Other primary glomerulonephritis Acute GN post infection: histologic lesions: endocapillary proliferative GN favorable prognosis in children, but adults are more prone to chronic renal insufficiency. Renal damage caused by primary hypertension renal damage is seen after a long term of hypertension. tubular dysfunction occur earlier than glomerular dysfunction. Renal damage caused by primary hypertension other target organs such as heart, brain are also affected. anemia is generally not as severe as that in primary GN. Treatment The main objective: retard the progression of renal damage treat complication Treatment Sur