四川大学华西第二医院：肾脏学（PPT课件讲稿）Nephrology Disorders

NEPHROLOGY DISORDERS Tao Yuhong hxtyh@sina.com

NEPHROLOGY DISORDERS Tao Yuhong hxtyh@sina.com

Primary glomerular diseases K glomerulonephritis O acute glomerulonephritis, AGN 2 rapidly progressive glomerulonephritis, RPGN 3 persistent glomerulonephritis o chronic glomerulonephritis 2. nephrotic syndrome, NS ① simple type Ns) ② nephritic type NS) 3. isolated hematuria or proteinuria ③ isolated hematuria 2 isolated proteinuria

Primary glomerular diseases 1. glomerulonephritis ① acute glomerulonephritis, AGN ② rapidly progressive glomerulonephritis, RPGN ③ persistent glomerulonephritis ④ chronic glomerulonephritis 2. nephrotic syndrome, NS ① simple type NS) ② nephritic type NS) 3. isolated hematuria or proteinuria ① isolated hematuria ② isolated proteinuria

Acute glomerulonephritis

Acute glomerulonephrits

Purpose and requirement o To understand the etiology, pathogenesis and pathology To master the clinical manifestations(common case severe case and atypical case), diagnosis and treatment To understand the differential diagnosis and prognosis

Purpose and requirement ❖ To understand the etiology, pathogenesis and pathology ❖ To master the clinical manifestations (common case, severe case and atypical case), diagnosis and treatment ❖ To understand the differential diagnosis and prognosis

Definition Glomerulus inflammation of the glomeruli enole sudden appearance of hematuria, proteinuria edema, and hypertension with or without oliguria postinfectious glomerulonephritis and immune mediated glomerulonephritis acute poststreptococcal glomerulonephritis Loop of Henle follow streptococcalinfections

➢ inflammation of the glomeruli ➢ sudden appearance of hematuria, proteinuria ， edema, and hypertension with or without oliguria ➢ postinfectious glomerulonephritis and immune mediated glomerulonephritis ➢ acute poststreptococcal glomerulonephritis ➢ follow streptococcal infections Definition

急性肾炎抗“0”升高 一急肾炎抗“0”正常 Age 百 肾病综合征 typically affects children 率 aged 5-15 years % 5% are younger than 2 years and 10% are older than 40 ars 年龄岁) 图1急性肾炎与肾病综合征发病年龄分布

Age • typically affects children aged 5-15 years •5% are younger than 2 years and 10% are older than 40 years

1.Etiology ◆β- hemolytic streptococcus, group A antigen components of cytoplasm membrane frequently CIC, sometimes 'planted antigen ◆ Others other bacteria ● viruses parasites

1.Etiology ♦ -hemolytic streptococcus, group A • antigen – components of cytoplasm & membrane – frequently CIC, sometimes ‘planted antigen’ ♦ Others • other bacteria • viruses • parasites

1.Etiology nephritogenic streptococci strains ◆ pyoderma M types47,49,55,2,60,and57 throat infection(pharyngitis) M types 1,2,4,3,25,49,and12

1.Etiology ➢ nephritogenic streptococci strains ♦ pyoderma M types 47, 49, 55, 2, 60, and 57 ♦ throat infection(pharyngitis) M types 1, 2, 4, 3, 25, 49, and 12

2. Pathology Gross examination Swollen with scattered petechia

2. Pathology Gross examination Swollen with scattered petechia

Noma| glomeru山us Post-streptococcal glomerulonephritis enlarged glomeruli relatively bloodless diffuse mesangial cell proliferation Increase in mesangial matrIX

Normal glomerulus Post-streptococcal glomerulonephritis ◼ enlarged glomeruli ◼ relatively bloodless ◼ diffuse mesangial cell proliferation ◼ increase in mesangial matrix