《(内科学ppt课件)02.慢性肾小球肾炎-english.ppt》由会员分享，可在线阅读，更多相关《(内科学ppt课件)02.慢性肾小球肾炎-english.ppt（44页珍藏版）》请在三一办公上搜索。
1、Chronic Glomerulonephritis,Li Manli,What is chronic glomerulonephritis(CGN)?,Another name is chronic nephritis.A group of primary glomerular diseases characterized by hematuria,proteinuria,edema and hypertension with or without renal disfunction.slowly and insidiously progress to end-stagerenal dise
2、ase(ESRD).,hematuria:gross hematuria and microscopic hematuria(the count of RBC in fresh urinary sediment is more than 3 per high power field under microscope)proteinuria:total 24hs protein amount is persistently more than 150mg,Etiology and Pathogenesis,unclearA small number due to acute post-strep
3、tococcal glomerulonephritis.,Etiology and Pathogenesis,Pathogenesis,immune factors,inflammation mediated by primary immunological reaction MAIN,non-immune factors,hypertensionsevere proteinuria hyperlipidemia(high blood fat)hyperuricemia(high uric acid)(etc)during disease process.,pathology,mesangia
4、l proliferative nephritismesangiocapillary glomerulonephritismembranous nephropathyfocal segmental glomerulosclerosis(FSGS)sclerosing glomerulonephritis,Clinical manefestation,edema:,hypertention,hypertention,female at the age of 31impaired visionophthalmologist fundus hemorragehypertention(160/102m
5、mHg)cardiologisturine analysis kidney fuction,hypertention,hypertention,hypertention,Clinical manefestation,edema;hypertention;gross hematuria;non-specific symptom：pain in the lumbar、fatiguechronic renal failureabnormal urine analysis without symptom,Laboratory tests,（1）urine analysis:hematuria，prot
6、einuria（2）blood test:blood routine：normal or mild anemia kidney function:BUN，Cr（3）B-ultrosound：size of the kidneys normal or small（4）renal biopsy：to make pathologic diagnosis,help therapy,and prognosticate,diagnosis,abnormal urine analysis(proteinuria and,or hematuria),edema,hypertention with or wit
7、hout renal disfunction,excluding secondary and hereditary glomerulonephritis.,Differential diagnosis,1.Lupus nephritis,seconary to Systemic Lupus Erythematosus(SLE),What is SLE?,A kind of autoimmune disease;Female more than male;Multiple system and organ involved;Specific immunological markers(ANA,a
8、nti-dsDNA antibody,anti-Sm antibody positive);,Manefestaion of SLE,Skin and joints:fever,baldness,oral ulcer,light sensitiveness,rash(erythema),joint pain,Manefestaion of SLE,Cardiovasular system(pericarditis,myocarditis)Polyserositis(hydrothorax,ascites,Pericardial effusion),Manefestaion of SLE,Lun
9、g:hydrothorax,interstitial peumonia,pulmonary arterial hypertentionNervous system:seizure,headache,confusionPsychiatric system:Hematologic system:anemia,leukopenia,thrombocytopeniaDigestive system:,Kidney:lupus nephritisIC widely deposit in Glomerular.IgG、IgA、IgM are positive.,Case report,female,23y
10、serythema,mild jont painPE:mild to moderate fever,erythemaLab tests:urine analysis:mild proteinuriablood routine:anemia,leukopeniadsDNA antibody:positive,Case report,Female,33ysedema,dypneaPE:edema,HR:105beat/minLab tests:urine analysis:proteinuria and hematuriablood routine:anemiadsDNA antibody,ant
11、i-Sm antibody:positivecardic ultrasound:pericardial effusionChest X-ray:hydrothorax,A long history of diabetes,then urinary abnormality.Evidence of other diabetic microvascular complications:such as diabetic retinal lesions or diabetic neuropathy.Glomerular hematuria is not obvious.,2.DN（diabetic ne
12、phropathy),DN（diabetic nephropathy),secondary to primary hypertention.history of primary hypertention more than 5-10 years;renal tubular disfunction occurs earlier thanglomerular injury;mild proteinuria;complicated with heart and brain injury,3.Benign arteriolar nephrosclerosis,caused by allergic pu
13、rpurahigh incidence in children.symmetrical purpura(the four limbs)hematuria,different levels of proteinuriajoint painabdominal pain and bloody stool,4.Purpura nephritis,Recurrent urinary tract infection history;Urine bacteriological examination often positive;Imageology examination:double kidney as
14、ymmetric shrink.,5.Chronic pyelonephritis,6.Alport syndrome positive family history,more onset in adolescent(10 years old);Kidney damage(hematuria,mild-to-moderate proteinuria and progressive renal impairment),deafness,eyes impaired7.other nephritisAsymptomatic hematuria or/and proteinuriaAcute post
15、-infection nephritis:A precursor infection then acute onset C3 dynamic changeself-healing tendency,treatment,Diet therapyBlood pressure controlSymptomatic treatment,Diet therapy,Water intake restriction when edemaLow salt diet when hypertentionLow protein diet when renal insufficent,Blood pressure c
16、ontrol,Systemic hypertension and high pressure in glomeruli are important risk factors accelerating the progress of kidney disease Drugs:ACEI(angiotensin converting enzyme inhibitor)ARB(angiotensin receptor blocker),reduce the renal capillary pressure decrease proteinuria protect renal fuction,Other
17、 antihypertensive drugs:diureticscalcium channel blockersbeta receptor blockers alpha receptor blockersTarget blood pressure:130/80 mmHg(proteinuria 1 g/d),Symptomatic treatment,control infectioneliminate edemadecrease proteinuria:glucocorticoid and immunosuppressive agentAvoid aggravating factors:k
18、eep away from infection,renal toxic medicine(some Chinese medicine,antibiotics,contrast agent,NSAID),prognosis,Progress slowly and continuously,whichwill eventually result in chronic renal failure.velocity of the progression depends on:Pathological typeThe degree of proteinuriaBlood pressure controlOther various risk factors(infection,medication,diet,etc.),Thanks for your attention,
