《儿科学》课程教学资源（授课教案）12 Acute Glomerulonephritis，Nephrotic Syndrome

重庆医科大学儿科学教案讲课题目教师：唐雪梅副教授授课题目TEACHINGTOPIC肾小球肾炎(Acute glomerulonephritis,AGN)肾病综合症(Nephrotic syndrome, NS)第几次课TIMES4th教学方法METHODSClass teaching 教学对象OBJECTIVESeven years students学时：TIME40×3 minutes教学目标PURPOSEAcute glomerulonephritis(AGN) :knowthe etiology,pathogenesis and pathology ofAGNmaster the clinical manifestations oftypical and severe AGNmaster the diagnosis and differentiation diagnosis of AGNmaster the treatment principles of typical and severe AGNNephroticsyndrome(NS)know the etiology and pathogenesis ofNSmaster the pathophysiology of NSmaster the clinical manifestations and differentiationdiagnosis ofsimpletypeNsvpeanfamiliar with the common complications of NSnaster the treatment principles of NS教学重点和难点Acute glomerulonephritis(AGN)PURPOSEI DIFFICULTIESknow the pathophysiology of AGNmaster the clinical manifestations of typical and severe AGNNephrotic syndrome (NS) :the pathophysiology of NSmaster the clinical manifestations and differentiondiagnosisofsimpletype and nephritic type NSmaster the treatment principles ofNS教学内容的深化与拓宽Introduction of the other pathogens related toAGN, eg, B19、EBV ;The developments

重庆医科大学儿科学教案 讲课题目 教师： 唐雪梅 副教授 授课题目 TEACHING TOPIC 肾小球肾炎(Acute glomerulonephritis, AGN) 肾病综合症(Nephrotic syndrome, NS) 第几次课 TIMES 4 th 教学方法 METHODS Class teaching 教学对象 OBJECTIVE Seven years students 学时: TIME 40×3 minutes 教学目标 PURPOSE Acute glomerulonephritis(AGN)： 1. know the etiology, pathogenesis and pathology of AGN 2. master the clinical manifestations of typical and severe AGN 3. master the diagnosis and differentiation diagnosis of AGN 4. master the treatment principles of typical and severe AGN Nephrotic syndrome (NS)： 1. know the etiology and pathogenesis of NS 2. master the pathophysiology of NS 3. master the clinical manifestations and differentiation diagnosis ofsimple type and nephritic type NS 4. familiar with the common complications of NS 5. master the treatment principles of NS 教学重点和难点 PURPOSE/ DIFFICULTIES Acute glomerulonephritis(AGN)： 1. know the pathophysiology of AGN 2. master the clinical manifestations of typical and severe AGN Nephrotic syndrome (NS)： 1. the pathophysiology of NS 2. master the clinical manifestations and differentiation diagnosis ofsimple type and nephritic type NS 3. master the treatment principles of NS 教学内容的深化与拓宽 The developments Introduction of the other pathogens related to AGN, eg. B19、EBV；

Introduction of podocyte damage in NS pathogenesisIntoductionof advanced immunosuppreoreg MMF and cyclosporineAin NS treatment教学要求的英语单词Acute glomerulonephritisEnglish requirementsAcute nephritic syndromeAcute post-streptococcal glomerulonephritisnephrotic syndromePrimary Nephrotic SyndromeIdiopathic NSNephritic NS实践性教学安排Typical cases demonstration and clinical workshopClinical study教材及参考资料沈晓明主编第七版《儿科学》TEXTUSEDIBOOKREFERENCES诸福堂第七版《实用儿科学》Nelson Textbook of Pediatric (16th edition )教具TEACHINGAIDSPPT、板书教学程序Procedures详细见讲稿主要内容及安排（教学内容详细安排、教学方法的运用、师生活动设计、及时间分配）：

Introduction of podocyte damage in NS pathogenesis; Introduction of advanced immunosuppressors, eg. MMF and cyclosporine-A, in NS treatment 教学要求的英语单词 English requirements Acute glomerulonephritis Acute nephritic syndrome Acute post-streptococcal glomerulonephritis nephrotic syndrome Primary Nephrotic Syndrome Idiopathic NS Nephritic NS 实践性教学安排 Clinical study Typical cases demonstration and clinical workshop 教材及参考资料 TEXT BOOK USED/ REFERENCES 沈晓明主编第七版《儿科学》 诸福堂第七版《实用儿科学》 Nelson Textbook of Pediatric （16th edition） 教具 TEACHING AIDS PPT、板书 教学程序 Procedures （教学内容详细安排、教学方法的运用、师生活动设计、及时间分配）： 详细见讲稿主要内容及安排

讲稿主要内容及安排时间安排备注（授课形式）（分钟）肾小球肾炎PPT60(Acute glomerulonephritis, ANG)[outline]1General IntroductionAcute post-streptococcal glomerulonephritis(APSGN)DefinitionEtiology and PathophysiologyPathologyClinical manifestationLab examinationDiagnosisPrognosisTreatment2[Synonyms]introduceAcuteconceptsofGlomerulonephritis, emphasize what we learnabout is APSGN.3[Definition] 1.Acutepost-streptococcal

讲稿主要内容及安排 备注（授课形式） 时间安排 （分钟） 肾小球肾炎 （Acute glomerulonephritis， ANG） PPT 60 [outline] 1 General Introduction Acute post-streptococcal glomerulonephritis (APSGN) Definition Etiology and Pathophysiology Pathology Clinical manifestation Lab examination Diagnosis Prognosis Treatment [Synonyms] 2 introduce 3 concepts of Acute Glomerulonephritis, emphasize what we learn about is APSGN. [Definition] 3 1. Acute post-streptococcal

glomerulonephritis is an Immune associateddisease include 4 clinical features of HematuriaedemaProteinuria,Oliguria,andHypertension.2. The most commonly seen renal disease. Peakprevalence in children is 5-14ys. Sporadic, butmostly in winter and spring. Affect boys moreoften than girls. M:F=2:14[Etiology]Glomerularofcirculatingtrappinganti-streptococcal immune complexes.GroupA, β-hemolytic streptococci.1. Acute upper respiratory tract infection (URI):type 122Skin infection: type 49[Pathogenesis]

glomerulonephritis is an Immune associated disease include 4 clinical features of Hematuria / Proteinuria, Oliguria, edema and Hypertension. 2. The most commonly seen renal disease. Peak prevalence in children is 5-14ys. Sporadic, but mostly in winter and spring. Affect boys more often than girls. M:F=2:1 [Etiology] 4 Glomerular trapping of circulating anti-streptococcal immune complexes. Group A, β-hemolytic streptococci. 1. Acute upper respiratory tract infection (URI): type 12 2. Skin infection: type 49 [Pathogenesis]

UnclearImmune-mediated damaging1. Humoral ImmunityCirculating immune complex (CIC)Planted Immune complex (PIC)2. Cellular Immunity , include T cells,Microphages,Complementsystem[Pathophysiology]51. Decrease of Glomerular filtration rate (GFR)Azotemia --- Bun t, Cr t, UA tOliguriaEdema, hypertension,hyperemiaGlomerularbasement2. Damagedinmembrane (GBM)Proteinuria, hematuria, cylinduria[Pathology]5

Unclear Immune-mediated damaging 1. Humoral Immunity Circulating immune complex (CIC) Planted Immune complex (PIC) 2. Cellular Immunity ， include T cells, Microphages, Complement system [Pathophysiology] 5 1. Decrease of Glomerular filtration rate (GFR) Azotemia - Bun↑, Cr ↑, UA ↑ Oliguria Edema, hypertension, hyperemia 2. Damaged in Glomerular basement membrane (GBM) Proteinuria, hematuria, cylinduria [Pathology] 5

Light MicroscopeEnlarged, hypercellular glomerularwith endothelial and mesangial cellproliferation.Electron MicroscopeIgG and C3 in granular pattern along“hump-GBMs. Discrete,subepitheliallike" deposits.Immune FluorescenceIgG and C3 in granular pattern along GBM20[Clinical Manifestations]nephriticAcutesyndromepost-streptpharyngitis or pyoderma and other infectionsTypical CasesHematuria / ProteinuriaEdemaOliguriaHypertensionSevere CasesHyperemia Vs. Heart failureHypertensive encephalopathyAcute renal failure (ARF)

Light Microscope Enlarged, hypercellular glomerular with endothelial and mesangial cell proliferation. Electron Microscope IgG and C3 in granular pattern along GBMs. Discrete, subepithelial “hump￾like” deposits. Immune Fluorescence IgG and C3 in granular pattern along GBM [Clinical Manifestations] 20 Acute nephritic syndrome post-strept pharyngitis or pyoderma and other infections Typical Cases Hematuria / Proteinuria Edema Oliguria Hypertension Severe Cases Hyperemia Vs. Heart failure Hypertensive encephalopathy Acute renal failure (ARF)

Atypical CasesAsymptomaticWithout renal SymptomWithNephroticSyndrome5[Laboratory Examination]Nephritic urine with RBC casts.Evidence of streptococal infection orserologicevidence of recent infection.DecreasedserumcomplementASot, ADPNase, ADNase-B, AHaseCH50I、C3 ↓、C4 ↓5[Diagnosis and Differential Diagnosis]Evidence ofa recent streptococcalinfectionClinical presentationLaboratory testsASOt, C3 ↓NoninfectionstreptococcalglomerulonephritisNephrotic syndrome (NS)glomerulonephritisRapidlyprogressive(RPGN)Chronic glomerulonephritis (CGN)

Atypical Cases Asymptomatic Without renal Symptom With Nephrotic Syndrome 【Laboratory Examination】 5 Nephritic urine with RBC casts. Evidence of streptococcal infection or serologic evidence of recent infection. Decreased serum complement. ASO↑, ADPNase, ADNase-B, AHase CH50↓、C3 ↓ 、C4 ↓ [Diagnosis and Differential Diagnosis] 5 Evidence of a recent streptococcal infection Clinical presentation Laboratory tests ASO↑, C3 ↓ Non streptococcal infection glomerulonephritis Nephrotic syndrome (NS) Rapidly progressive glomerulonephritis (RPGN) Chronic glomerulonephritis (CGN)

Secondary glomerulonephritis (SGN)2[Prognosis]8[Treatment]Symptomatic treatmentRestDietElectrolyte and renal functionAntibioticsOliguria and Edema managementHypertensionHypertensive encephalopathyAcute renal failure备注（授课形式）时间安排（分钟）肾病综合症PPT60(Nephrotic syndrome, NS)[outine]1

Secondary glomerulonephritis (SGN) [Prognosis] 2 [Treatment] 8 Symptomatic treatment Rest Diet Electrolyte and renal function Antibiotics Oliguria and Edema management Hypertension Hypertensive encephalopathy Acute renal failure 备注（授课形式） 时间安排 （分钟） 肾病综合症 （Nephrotic syndrome， NS） PPT 60 [outline] 1

DefinitionClassificationPathologyEtiologyand PathophysiologyClinical manifestationComplicationsDiagnosisTreatmentPrognosis2[Definition and General information][Classification]Primary NS > 90% in Children2Secondary NSCongenital NS[Primary Nephrotic Syndrome]5[Classification]Clinical typesResponse to SteroidsPathological types2[Pathology][Etiology]3

Definition Classification Pathology Etiology and Pathophysiology Clinical manifestation Complications Diagnosis Treatment Prognosis [Definition and General information] 2 [Classification] Primary NS > 90% in Children Secondary NS Congenital NS 2 [Primary Nephrotic Syndrome] [Classification] 5 Clinical types Response to Steroids Pathological types [Pathology] 2 [Etiology] 3

1. T cell-mediated immunity disorderElectrostatic Barrier -- MCNS2.Immune complexMolecular Barrier---Non MCNS10[Pathophysiology]ProteinuriaHypoalbuminemiaHyperlipedemiaEdema9[Clinical manifestations]

1. T cell-mediated immunity disorder Electrostatic Barrier - MCNS 2. Immune complex Molecular Barrier - Non MCNS [Pathophysiology] 10 Proteinuria Hypoalbuminemia Hyperlipedemia Edema [Clinical manifestations] 9