儿科学-急性肾小球肾炎、肾病综合征（英文版）PPT课件

1、,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,Acute Glomerulonephritis Nephrotic syndrome,Symptoms of urinary tract disease,Dysuria,排尿困难,Polyuria,多尿,Micturition,尿频,Incontinence of urine,尿失禁,Hematuria,血尿,Proteinuria,蛋白尿,Hypertention,高血压,Oliguria,少尿,Edema,水肿,kidney,ureter,bladder,Causes of,hematuria,Non-glomerular:,Infection,Trauma,外伤,Tumours,肿瘤,Sickle disease,Bleedi

2、ng disorder,出血性疾病,Renal vein thrombosis,肾静脉血栓,Hypercalciuria,高钙尿症,Glomerular diseases:,Acute glomerulonephritis,Chronic glomerulonephritis,IgA nephropathy,Familial nephritis,Thin basement membrane disease,薄基底膜病,Acute Glomerulonephritis,，,AGN,Acute glomerulonephritis,:,Acute-onset,A panel of diseases with different etiology and pathogenesis,Typical manifestation:,Hematuria,Edema,Hypertention,Renal insufficiency,(Acute nephritic syndrome),NS,AGN,Epidemiological Investigation Of Urine System In Hos

3、pitalization,1.,post-streptococcal glomerulonephritis,2.No-,post-streptococcal glomerulonephritis,细菌性感染：草绿色链球菌、肺炎球菌、金黄,色葡萄球菌、伤寒杆菌等,病毒感染：乙型肝炎、巨细胞病毒、水痘、,EB,病毒等,梅毒、钩端螺旋体、支原体等,其他,:,原发性肾小球疾病、多系统疾病,Classification Of AGN,Acute post-streptococcal,glomerulonephritis,(APSGN),急性链球菌感染后肾小球肾炎,Outline:definition,Immune associated disease,Follows infection of the throat or skin with group A-hemalytic streptococci.,Clinical feature,s,:,Hematuria/Proteinuria Oliguria,Edema Hypertension,Renal insufficiency,(,Bun,C

4、r,GFR,),Most common cause for,gross,hematuria,（肉眼血尿）,in Chi,ldren,Morbidity:0-20%after streptococcal infection,Seasonality:Spring and Autumn,Age:5-14 yo,rare under 2 yo,Gender:M:F=2:1,Outline:general infomation,Etiology,Follows infection of the throat or skin with certain“nephritogenic”strains,致肾炎菌株,of group A betta-hemolytic streptococci,Pathway:,Winter:streptococcal pharyngitis,(serotype 12),咽峡炎,Summer:streptococcal skin infection,pyoderma(serotype 49),脓皮病,Etiology,Host susceptibility,The dise

5、ase incidence of patients family members is higher than the general population(38.7%).,HLA DRW4 detection rate is higher,Pathogenesis,The precise mechanisms remain unclear.,Immune complexes mediated:,The gap time between antecedent infection and onset of APSGN is the same long as the production of antibodies,There are obvious evidences of deposits of immune complex instead of bacteria,Pathogenesis,Immune complex play the most importent role,Antigens of nephritogenic strain of streptococci,Immune

6、 complex in situ type,Anti,-,GBM,-,antibodies,CIC,Activated complments and inflammatory mediators,Inflammation of glomeruli,原位免疫复合物,诱发自身免疫,链球菌致肾炎菌株抗原成分,循环免疫复合物,激活补体及其他炎症介质,肾小球免疫损伤,Pathogenesis,免疫复合物是最主要原因！,Pathology,Features:,diffuse,弥漫性,proliferative,增生性,e,xudative,，,渗出性,glomerulonephritis,endothelial cell,podocyte,mesangial cell,endothelial cell,epithelial cell,mesangial cell,leukocyte,diagram of glomeruli,proliferation of endothelial cells and mesangial cells,effusion of leukocytes in lumen,P

7、AS,400,Normal glomerul,i,PAS,400,Glomerular nephritis,Light Microscope,:,capillaries proliferative glomerulonephritis,毛细血管内,增生性肾小球肾炎,Enlarged,hypercellular glomeruli with endothelial and mesangial cell proliferation.,EM,10,000,Glomerular nephritis,EM,10,000,Normal glomerul,i,Electron Microscope,electron-dense deposits on the epithelial side of the GBM,驼峰样电子致密物沉积在上皮下,Immune Fluorescence,lumpy-bumpy deposits of,IgG and C,3,on GBM,or,in,mesangium,IF,400,Glomerular nephritis,肾单位,Tubules,肾小管,renal co

8、rpuscle,肾小体,glomeruli,肾小球,Bowmans capsule,肾小囊,Pathophysiology,nephron,肾单位,Pathophysiology,renal corpuscle,肾小体,Pathophysiology,The glomerular capillary loops,肾小球,毛细血管袢,肾小球炎症病变,内皮细胞肿胀、系膜细胞增生,毛细血管管腔狭窄,肾小球血流量,滤过面积,肾小球滤过率,球管失衡,钠、水潴留，血容量扩张,肾小球基底膜破坏,血 尿,蛋白尿,管型尿,氮质血症,少尿、无尿,水肿,高血压,循环充血,Pathophysiology,Pathophysiology,Inflammation of glomeruli,Impairment of GBM,Effusion of,leukocytes,proliferation of mesangial cells,and,endothelial,cells,GFR,BUN and,S,Cr,Imbalance of glomeruli-tubulus,oliguria,Water and s

9、alt retention,Edema,hypertension and Circulatory Congestion,Hematuria and proteinuria,Clinical manifestations:,Antecedent infection:,90%APSGN with antecedent streptococcal infection,Pharyngitis:6-12 days(average 10 days)before onset,Skin infections:14-28 days(average 20 days)before onset,Different features of APSGN caused by throat or skin infection,APSGN caused by Pharyngitis,APSGN caused by Pyoderma,Serotype,12(1,3,4),49(2,5,47),Climate,Spring,Summer or autumn,Age,School age,Pre-school age,Int

10、ermission,About 10 days,About 20 days,Hematuria/Proteinuria,Edema,Oliguria,Hypertension,Clinical manifestations:,Typical manifestation,典型病例,Severe manifestation,重症病例,Asymptomatic manifestation,不典型病例,Clinical manifestations:Typical manifestations,Hematuria:50-70%gross hematuria,肉眼血尿,with RBC casts,sometimes microscopic hematuria,镜下血尿,Normal,Pink,Red,Dark gray,Brown,Proteinuria:,Usually+-+,24-h urine protein,quantitati,on,24,小时尿蛋白定量,：,130/90mmHg for school children,120/80mmHg for pre-school childr

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