(内科学课件)02慢性肾小球肾炎-english.ppt

1、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 disease(ESRD).hematuria:gross hematuria and microscopic hematuria(the count of RB

2、C in fresh urinary sediment is more than 3 per high power field under microscope)proteinuria:total 24hs protein amount is persistently more than 150mgunclearA small number due to acute post-streptococcal glomerulonephritis.Pathogenesis MAINhyperlipidemia(high blood fat)mesangial proliferative nephri

3、tismesangiocapillary glomerulonephritismembranous nephropathyfocal segmental glomerulosclerosis(FSGS)sclerosing glomerulonephritis edema:female at the age of 31impaired visionophthalmologist fundus hemorragehypertention(160/102mmHg)cardiologisturine analysis kidney fuctionedema;hypertention;gross he

4、maturia;non-specific symptom：pain in the lumbar、fatiguechronic renal failureabnormal urine analysis without symptom（1）urine analysis:hematuria，proteinuria（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

5、 pathologic diagnosis,help therapy,and prognosticate abnormal urine analysis(proteinuria and,or hematuria),edema,hypertention with or without renal disfunction,excluding secondary and hereditary glomerulonephritis.seconary to Systemic Lupus Erythematosus(SLE)A kind of autoimmune disease;Female more

6、than male;Multiple system and organ involved;Specific immunological markers(ANA,anti-dsDNA antibody,anti-Sm antibody positive);Skin and joints:fever,baldness,oral ulcer,light sensitiveness,rash(erythema),joint painCardiovasular system(pericarditis,myocarditis)Polyserositis(hydrothorax,ascites,Perica

7、rdial effusion)Lung: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.female

8、,23yserythema,mild jont painPE:mild to moderate fever,erythemaLab tests:urine analysis:mild proteinuriablood routine:anemia,leukopeniadsDNA antibody:positiveFemale,33ysedema,dypneaPE:edema,HR:105beat/minLab tests:urine analysis:proteinuria and hematuriablood routine:anemiadsDNA antibody,anti-Sm anti

9、body:positivecardic ultrasound:pericardial effusionChest X-ray:hydrothoraxA 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 nephropathy)s

10、econdary 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 injurycaused by allergic purpurahigh incidence in children.symmetrical purpura(the four limbs)hematur

11、ia,different levels of proteinuriajoint painabdominal pain and bloody stool4.Purpura nephritisRecurrent urinary tract infection history;Urine bacteriological examination often positive;Imageology examination:double kidney asymmetric shrink.5.Chronic pyelonephritis 6.Alport syndrome positive family h

12、istory,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-infection nephritis:A precursor infection then acute onset C3 dynamic change

13、self-healing tendency Diet therapyBlood pressure controlSymptomatic treatmentWater intake restriction when edemaLow salt diet when hypertentionLow protein diet when renal insufficentSystemic hypertension and high pressure in glomeruli are important risk factors accelerating the progress of kidney di

14、sease Drugs:ACEI(angiotensin converting enzyme inhibitor)ARB(angiotensin receptor blocker)reduce the renal capillary pressure decrease proteinuria protect renal fuctionOther antihypertensive drugs:diureticscalcium channel blockersbeta receptor blockers alpha receptor blockersTarget blood pressure:13

15、0/80 mmHg(proteinuria 1 g/d)control infectioneliminate edemadecrease proteinuria:glucocorticoid and immunosuppressive agentAvoid aggravating factors:keep away from infection,renal toxic medicine(some Chinese medicine,antibiotics,contrast agent,NSAID)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.)