内科学教学课件：英文肾小球疾病.pptVIP

【Pathology】 Endocapillary proliferative glomerulonephritis→ endothelial mesangial cells Crescents are uncommon. Immunofluorescence microscopy reveals diffuse granular deposition of IgG and C3 in subendothelial and mesangial areas. The characteristic finding on election microscopy is the presence of large electron-dense immune deposits in the subepithelial areas. Endocapillary proliferative ↓ ↑ Normal glomerulus 【Clinical manifestation Lab.Exam】 Often kids(2-6 years) are involved, Male is more than female; Incubation period for about 1～3 weeks (mean 10 days). Prognosis may be satisfied. 2. Urine abnormality: glomerular originated hematuria (almost all); dysmorphic RBC, moderate proteinuria; WBC and epithelium ↑, granular casts and RBC cast in early stage; 【Clinical manifestation Lab.Exam】 3. Edema; typical eyelid 4. HBp: water sodium retention 5.olyguria(400ml/d),moderate azotemia. mild acute renal failure 6. heart failure: water sodium retention and hypertension 7. C3 decrease but restore in 8 weeks, serumal ASO may increase 8. Generalized symptoms: anorexia, nausea, vomiting, malaise. Swelling of the renal capsule can cause flank or back pain. 【diagnosis deferential diagnosis】 1.Other acute nephritis syndrome: ①pathogen (bacteria/ virus/ parasite) →C3 is normal; ②mesangiocapillary nephritis→ continuous hypocomplementemia can not restore in 8 weeks, nephrotic syndrome, no spontaneous cure. ③mesangial proliferative nephritis→ normal C3 ; no spontaneous cure; hematuria earlier 【diagnosis deferential diagnosis】 2.RPGN:rapidly deteriorate renal failure 3.Systematic disease: SLE or purpura 4.Indication of renal biopsy: ① olyguria for more than 1 week or gradually olyguria companied by azotemia② course continue beyond 2 months ③ AGN companied by nephrotic syndrome 【treatment】 1. Rest until the symptom alleviated; salt, water and protein should be limited. 2. Antibiotics→ penicillin 10－14days 3. Diur