血尿相关知识课件.pptVIP

血尿 定义 肉眼血尿：每1000ml尿液中混入1ml血液（RBC50/HP） 镜下血尿：RBC5/HP 发病机制 免疫反应导致基底膜损伤：肾小球性血尿 血管的直接破坏：高钙尿症、肾结石、肿瘤等 滤过膜通透性增加：肾静脉血栓、肾动脉硬化、左肾静脉受压综合征等 出凝血机制障碍：血友病、血小板减少性紫癜、新生儿自然出血症等 病因 肾小球性：IgA肾病，Alport综合征，薄基底膜病，AGN，H SPN，LN，HUS等 非肾小球性：原发性高钙尿症、解剖异常、感染、结石、创伤、药物等 血尿诊断流程 病史：家族史、药物史、乙肝病史、既往史 尿RBC形态检查 肾小球性血尿：BP、肾功能、乙肝两对半、Ig、补体、肾活检 非肾小球性血尿： B超，尿Ca/Cr，OX/Cr 血尿门诊常规 病史：家族史、药物史、乙肝病史、既往史 PE：BP LAB：尿RBC形态检查、肾功能、 B超，尿Ca/Cr，乙肝两对半、Ig、补体 肾小球性血尿疾病介绍 IgA Nephropathy 急性肾小球肾炎 Alport综合征 薄基底膜病 IgA Nephropathy 儿童单纯性血尿常见病因 男性多于女性，年长儿发病率高 可出现发作性肉眼血尿或镜下血尿 上呼吸道感染易诱发肉眼血尿 约1/3儿童IgA升高 诊断：肾活检IM：系膜区IgA沉积 Background The commonest pattern of primary glomerulonephritis, it’s prevalence varies widely among counties( in Jap, Fran, Ital, Aust: 18-40%, in USA, UK, Cana: 2-10%)(maybe related in part to differentindication for renal biopsy in different countries) Initially considered a benign condition, but extended follow-up showed it caused ESRD in 15-20% of individuals with 10Y of onset and in 30-35% of individuals within 20Y of onset Follow up 241 children: 5% developed CRF by 5Y from onset, 6% by 10Y, and 11% by 15Y--Japan An IgA case in RCH Patient: ADAM PHILLIP 0953582 Gender: M DOB: 25/03/1987 5/2000 1st admission: Macrohematuria for six months, Proteinuria: 4.82g/24hr, Bp 165/80mmHg 11/2000 RB: Diffuse mesangial proliferative glomerulonephritis, 6/12 glomeruli showed partial or complete sclerosis with fibrous crescent formation., foci of tubular atrophy, interstitial fibrosis, blood vessels are normal 3/2003: HD Specific Management of IgA Nephropathy----The CARI Guidelines Steroid therapy may be considered for patients with IgA nephropathy with persistent and heavy proteinuria (3g/day) (level A evidence) an initial dose of approximately 1mg/kg/d with a gradual tapering over the duration of treatment, it seems reasonable to use 6-12 months. Steroid therapy may also be considered for other patients with IgA nephropathy and moderate proteinuria (1-3g/day) and at risk of progressive renal failure as evidenced by: