1、1The urinary system Paediatrics of 1st hospital affiliated Dalian medical university马 路 一23Physiological featuresvGlomerular filtration rate ( GFR) : low in neonate and infant periodvUrine concentration and dilution ability shortagevRenal tubule function insufficiency4Physiological FeaturesNormal ur
2、inary output: neonate: 48h 13ml/kg.h 310d 100300ml/d 2m 250400ml/d 1y: 400500 ml/d 3y: 500600 ml/d 5y: 600700 ml/d 8y: 6001000 ml/d 14y: 8001400 ml/d 14y: 10001600 ml/d 5Physiological featuresurinary output neonateml/kg.hInfant toddler ml/dPreschool ageml/dSchool ageml/doliguria1.0200300400urineless
3、0.5 506UrinalysisvColor : colorless or light yellowvpH : 57vSpecific gravity : 1.0031.030 (often 1.0111.025)vOsmotic pressure : infant: 50600mmol/L children: 500800mmol/LPhysiological features7Urinalysisprotein： negative：100mg/m2.24h protein creatinine . positive： 150mg/d or4mg/m2.h or100mg/LUrinary
4、 cell and cast： Urinary sediment: RBC3/HP WBC5/HP colorless cast occasionally 12h urine Addis count：RBC500000 WBC1000000 cast5000 Physiological Features8Serum analysisThe standard indicators of renal function urea nitrogen and creatinine The ratio : 10:1. The ratio increase : renal perfusion or urin
5、e flow is decreased 9Section 2Classification of Glomerular Disease10Clinical Classification一一、Primary Glomerular Disease Glomerulonephritis acut glomerulonephritis (AGN) (Acute poststreptococcal glomerulonephritis,APSGN ) rapidly prograssive (RPGN) persistent chronic11Clinical Classification niphrot
6、ic syndrome,NS simple Type NS nephritic Type NS steroid-responsive NS steroid-resistant NS steroid-dependent NS relaps and frequently relaps12Clinical Classification Isolated hemarutia or proteinuria Isolated hematuria persistent recurrent Isolated Proteinuria orthostatic non-orthostatic 13Classific
7、ation Classification二二、Secondary glomerular diseases purpura nephritis lupus nephritis HBV-associated glomerulonephritis others:poison,drug,virus et.al三三、Hereditary glomerular diseases congenital nephrotic syndrome hereditary progressive nephritis familial recurrent hematuria14 Section 3Acute glomer
8、ulonephritis AG急性肾小球肾炎急性肾小球肾炎Acute poststreptococcal glomerulonephritis APSGN 急性肾小球肾炎急性肾小球肾炎15Etiologyv group A -heamolytic streptococcal infection. upper respiratory tract infection 51% skin infection 25.8% acute pharyngtis，scarlet fever 15%v others bacteria Virus helminth16Nephritis strain associa
9、ted protein (Ag)antigen-antibody complexesactivate the complement system incite glomemlar inflammation Cap.endotheliumGMBGFR Na,wateredemahypertensionProteinuria hematuria castMechanism17Clinical manifestationv 612 days previously 1428 days previouslyrecent history of group A -heamolytic streptococc
10、al infection. 18Clinical manifestation1. 1. edema 70%，eyelid and face， non-pitting； 2. 2. hematuria 505070%, 70%, gross hematuria coffee-colored or tea-colored urine Typic form19Clinical manifestation3. hypertension 3080%, headache may be present 4. Proteinuria degree is different pathology: membran
11、oproliferation Typic form20Clinical manifestationSevere hyperaemia on the circulatory systemHypertensive encephalopathyAcute renal failure severe form21Clinical manifestationvAsymptoms AGNvOut of renal symptoms AGNvAGN which is similar to nephrotic syndrom22 hematuria： ESR： ASO： C3： protein: Laborat
12、ory evaluation 23Diagnoses previously streptococcal disease acute onset edema , hematuria , Proteinuria , cast , hypertension ASO ，C3 24TreatmentRest: keep the bed 23W Non-symptom: Be off the bed ESR normal: go to school Urinary sediment count: normal, resume movementGenerally treatment 25diet Edema
13、 and hypertension: Water and sodium salt: be limited sodium salt: 60mg/(kg.d) water: potentially loss water volume urine outputlimited Generally treatment26TreatmentFor infection if still presentPenicillin 10 1014d14dAntibiotic therapy 27TreatmentdiureticsantihypertensiveDihydrochlorothiazideFurosem
14、ideNifedipineCaptoprilReserpineSymptomatic treatment28TreatmentSevere hyperaemia Hypertensive encephalopathyAcute renal failurediuretics、antihypertensive、hemodialysis or peritoneal dialysis Sodium Nitroprusside: the first choices,Symptomatic treatmentSymptomatic treatment according to various manife
15、station29Prognosis and preventv The acute abnormalities generally resolve in 2-3 weeks; v key point of prevention: prevent and cure infection 30Section 4Nephrotic syndrome NS 肾病综合征肾病综合征31Introdution It is glomerular disease, which has characteristic clinical and laboratory findings, cause by various
16、 factors. Age :school age male:female：3.7 : 1 32Characteristicv proteinuriav hypoproteinemia （hypoalbuminemia）v hyperlipemia and hyperlipoproteinemiav edema33Classification1.primary nephrotic syndrome,PNS2. secondary nephrotic syndrome,SNS3. congenital nephrotic syndrome,HNS 34Pathophysiology Primar
17、y renal injury proteinuria hypoproteinemia edema hyperlipidemia secondary Pathophysiological change35Glomemlar capillary vassel molecule and static barrier分子屏障分子屏障静电屏障静电屏障分子屏障分子屏障plasm protein molecule with various diameter36Clinical Finding and diagnosisAccording to Clinical Finding 1. simple type
18、NS 2. nephritic type NS37Clinical manifestation and diagnosis1. simple type NS 1) proteinuria: urine protein 3urine protein 34 4 24h urine protein quantitate50mg/kg24h urine protein quantitate50mg/kg 2) hypoproteinemia ： plasm plasm albuminalbumin25g/L25g/L 3) hyperlipidemia ： plasm plasm cholestero
19、lcholesterol 5.7mmol/L5.7mmol/L 4) edema ： the serious case:the serious case: anasarca anasarca，ascites, ascites, pleural effusions pleural effusions38Clinical Finding and diagnosis2. nephritic type NS There is one or more of items under line: hematuria ： Urinary sediment: 3 times within 2W RBC10/HP
20、 hypertension： school age 130/90mmHg, preschool age 120/80mmHg。 renal failure persistent hypocomplementemia 39Complication1. infection respiratory tract skin urethra peritonitis40Complication2. electrolyte disorder and intravascular volume depletion3. thrombosis and hypercoagulability renal vein thr
21、ombus is common41Complication 4. acute renal failure 5. growth and develop is retarded42TreatmentGenerally 1. rest 2. diet: Water and sodium salt are limited protein：1.52g/kgd Calcium and VitD； 3. diuretics: Dihydrochlorothiazide Furosemide 4. prevention and cure infection43TreatmentCorticosteroid t
22、reatment ： As soon as the diagnosis is made, corticosteroid treatment should be started. Predinisone: 2 mg/kg.d ( maximum, 80 mg/d ),6W 1.5mg/kg，single dose, qod, po,6W then, Gradually reduce the dosage Treatment for 9 to 12 months 44Curative effect evaluation1.steroid-responsive: Prednisone,4W urin
23、e protein(-)2.steroid-resistant： Prednisone, 4W, urine protein(+)3.steroid-dependent: It is responsive for Prednisone . If tapered or discontinued, it will be followed by relapse within two week.45Curative effect evaluationvRelapse 3 consecutive days, urine protein from (-) to 34 or 24h urine protei
24、n 50mg/kg, or urine protein/2.0 vfrequently relapse： relapse2 times within 6M，or3 times within 1Y。46vClinical curevComplete remission(CR)vPartial remission(PR)vNo remission Curative effect evaluation47vImmunosuppressant Cytotoxic agents can be considered For the case of corticosteroid dependence and resistanceo Anticoagulino ACEIo Others 48Email: main8251163
