《儿科学》课程教学课件（PPT讲稿）13 Acute Glomerulonephritis，Nephrotic Syndrome

Acute Glomerulonephritis,二AGN

Acute Glomerulonephritis, AGN

Synonyms Acuteglomerulonephritis急性肾小球肾炎Acute nephritic syndrome急性肾炎综合症 Acute post-streptococcalglomerulonephr it is(APSGN)

Syn on yms □ Acute glomerulonephritis急性肾小球肾炎 □ Acut e nephrit ic syndr ome急性肾炎综合症 □ Acute post-streptococcal glome r ulone phrit is (APS GN)

Acute PoststreptococcalGlomerulonephritis(APSGN)

Acute Poststreptococcal Glomerulonephritis (APSGN)

ContentsDefinition·Etiology and Pathogenesis.Pathology.Clinical manifestations.Lab examination·Diagnosis·Prognosis.Treatment

Con ten ts • Definition • Etiology and P athogenesis • Pathology • Clinical manifestations • Lab examination • Diagnosis • P r ognosis • Treatment

Definition·Hematuria（血尿）/Proteinuria（蛋白尿）Oliguria（少尿）（Bun，Cr，GFREdema（水肿）(saltandwaterretention)Hypertension（高血压）Immune associateddisease免疫介导的疾病

Definition • Hematuria(血尿）/ Proteinuria（蛋白尿） Oliguria（少尿） (Bun , Cr , GFR ) Edema（水肿） (salt and water retention) Hypertension（高血压） • Immune associated disease 免疫介导的疾病

GeneralinformationThe most common renal disease(causeofgross hematuriainchildren)Incidence:Peakincidence in childrenis5-14ys.Sporadic(散发),mostlyinwinterand spring.Affectedboys moreoftenthangirlsM:F=2:1

General information • The most common renal disea se (cause of gr o ss hematuria in children) • Incidence: Peak incidence in children is 5-14ys. Sporadic(散发), mostly in winter and spring. • Affected boys more often than girls. M:F=2:1

EtiologyGlomerular trapping of circulating anti-streptococcal immune complexes.GroupAβ-hemolyticstreptococci.（A组β溶血性链球菌Acute upper respiratory tractinfection (URI):type 12 Skin infection: type 49

Etiology Glomerular trapping of circulating anti￾streptococcal immune complexes. Group A, β-hemolytic streptococci.(A组β溶血性链球菌） □ Acute upper respiratory tract infection (URI): type 12 □ Skin infection: type 49

PathogenesisUnclearImmune-mediateddamaging（免疫介导的损伤）HumorImmunity体液免疫Circulativeimmunecomplex（循环免疫复合物，CIC)PlantedImmunecomplex（原位免疫复合物·PIC)CellularImmunity细胞免疫Tcells,Microphages,Complement system

Pathogenesis Unclear Immune-mediated damaging（免疫介导的损伤） • Humor Immunity 体液免疫 Circulative immune complex (循环免疫复合物，CIC) Planted Immune complex (原位免疫复合物，PIC) • Cellular Immunity 细胞免疫 T cells, Microphages, Complement s ys tem

PathophysiologyGlomerular injuryInflammation of glomerular capillarybedDecreased glomerular capillary perfusionDecreased GFRIncreased Na and H,OreabsorptionDecreased tubular fluid,IncreasedECFRenal failure

Inflammation of glomerular capillary bed Decreased tubular fluid, Increased ECF Decreased GFR Glomerular injury Renal failure Decreased glomerular capillary perfusion Increased Na and H2O reabsorption Pathophysiology

肾小球炎症病变肾小球基底膜破坏内皮细胞肿胀·系膜细胞增生毛细血管管腔狭窄蛋白尿血尿肾小球滤过面积管型尿氮质血症肾小球滤过率球管失衡少尿、无尿水肿高血压钠·水潴留，血容量扩张循环充血

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 蛋白尿 血 尿 管型尿 氮质血症 少尿、无尿 水肿 高血压 循环充血