1、 Chronic Glomerulonephritis （慢性肾小球肾炎）Department of Nephrology, Tongji Hospital, HUSTMin Han, Ph. D & M.DDefinitionChronic glomerulonephritis is characterized by persistent moderate or heavy proteinuria and/or hematuria, symmetrically contracted kidneys and renal insufficiency that progresses slowly
2、over years. Etiology and Pathogenesis Most of chronic glomerulonephritis comes from a variety of different causes and different pathological patterns of primary glomerulonephritis Only a few of chronic glomerulonephritis comes from acute nephritis Immunological mechanism is involved in the pathogene
3、sis of chronic glomerulonephritis Some risk factors, such as hypertension, proteinuria, high cholesterol, promote the progress of chronic glomerulonephritisPathology Chronic glomerulonephritis can be a manifestation of virtually all of the major glomerulopathies. If a renal biopsy is performed early
4、 on , it may be possible to reach a precise diagnosis of the cause, such as membranous nephropathy, IgA nephropathy, focal segmental glomerulosclerosis, mesangial proliferative disorder Eventually it will progress to sclerosing glomerulonephritis with glomerular scarring or sclerosis, tubulointersti
5、tial inflammation and scarring. 膜性肾小球肾炎。肾小球毛细血管壁有许多粉红膜性肾小球肾炎。肾小球毛细血管壁有许多粉红色上皮下沉积物和黑色色上皮下沉积物和黑色“钉突钉突”。 PASM x PASM x 10001000硬化性肾小球肾炎晚期。肾皮质中有硬化性肾小球肾炎晚期。肾皮质中有2 2个几乎完全硬化的肾小球和个几乎完全硬化的肾小球和1 1个节段性硬个节段性硬化的肾小球，肾小管萎缩、扩张。化的肾小球，肾小管萎缩、扩张。 PAS x 100PAS x 100肾小球纤维化，肾小管萎缩，肾间质炎症细胞浸润Clinical presentations Insidious
6、onset, slow progress Proteinuria, hematuria, hypertention, edema Renal insufficiency Fatigue, anorexia, sleep and taste disturbance, electrolyte disorders The time to progression to ESRD is variable, hastened by uncontrolled hypertension, infections or other risk factors. Urinalysis: proteinuria, he
7、maturia, broad casts in urinary sediment Routine blood test: light anemia Elevated blood urea nitrogen and creatinine Bilateral small kidneys on abdominal imagingLaboratory FindingsDiagnosislAbnormal urinalysis, edema, hypertentionlExclude the secondary or hereditery glomerulonephritisl Acute glomer
8、ulonephritisl Diabetic nephropathyl Hypertensive renal damagel Secondary Nephritis: SLEl Hereditary disease: Alport Syndromel Chronic pyelonephritisDifferntial DiagnosislAsymptomatic urinary abnormalities I Hematuria with or without proteinuriaA.Primary glomerular diseases IgA nephropathy Mesangioca
9、pillary glomerulonephritis Other primary glomerular hematurias accompanied by “pure” mesangial proliferation, focal and segmental proliferative glomerulonephritis, or other lesions B.Associated with multisystem or hereditary diseases Thin basement membrane disease, Alport syndrome, Fabrys disease, S
10、ickle cell diseaseC.Associated with infections Resolving poststreptococcal glomerulonephritis Other postinfectious glomeruloneprhitis II Isolated nonnephrotic proteinuriaA.Primary glomerular diseases “orthostatic” proteinuria Focal segmental glomerulosclerosis Membranous glomerulonephritis B.Associa
11、ted with multisystem or hereditary diseases Diabetic mellitus Amyloidosis Nail-patella syndromeTreatmentControl the intake of protein and phosphorus Dietary protein restriction: 0.6-0.8g/Kg/d Alpha-keto acid: 0.1-0.2/Kg/d Control blood pressure ACEIARBCCBdiureticsProteinuria =1.0g/24h, Bp130/80mmHgP
12、roteinuria=1.0g/24h, Bp140/90mmHgAnti-infectious treatment, keep water, electrolyte and acid-base balance Clear toxinsAvoid the risk factor which damage the kidneys Steroid and immunosuppressive agents Depends on the pathological patterns, proteinuria, renal function.PrognosisThe outcome varies depending on the cause.Some patients develop ESRD and require renal replacement therapy with dialysis or transplantation. Thank you for your attention!
