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1、 Acute GlomerulonephritisBeijing Childrens Hospital affiliated to Capital University of Medical Sciences Meng QunAcute GlomerulonephritisnDefinition nEtiology and PathogenesisnPathologynClinical featuresnLaboratory findingsnDiagnosis and differential diagnosisnTreatmentDefinitionnacute onsetnpostinf
2、ectious glomerulonephritis: pharyngitis or pyodermanoften belong to acute poststreptococcal glomerulonephritis(APSGN)nresult of inflammatory glomerular injuryDefinitionnhematuria nproteinurianedema nhypertension nrenal insufficiencyncommon age: 514y 150160/100110mmHgreason: CNS vasculitismanifestati
3、ons:headache vomiting confusion somnolence convulsion comaSevere case(3)nacute renal failure : last 35d, 5.72mmol/L or 220mg/dledemaDifferential diagnosis(1) Nephritic type NS above points + at least as followsnurine test : dysmorphic red blood cellRBC10/HP 3 times 2 weeksnhypertention:school age ch
4、ildren 130/90mmHg pre-school age children 120/80mmHgnrenal function insufficiency npersistent complementnSecondary NS :APSGNLupus nephritisPurpura nephritisHBV-associated glomerulonephritisDifferential diagnosis(2) Treatment :General treatment nrest in bedndietary: salt 12g/dhigh quality protein 1.5
5、2g/kg.dVit D 400u/d,Cansevere edema and hypertension:limit liquid and saltantihypertensiondiuretics ncontrol and prevent infectionnknowledge educationCorticosteroid therapynPrednisone: 2mg/kg.dmaximum 60mg/dnprinciple:enough dosageslowly taperlong remainVitD,CalciumNew patients:nshort term therapy:
6、8 weeksprednisone 2mg/kg.d4w1.5mg/kg.qod 4wnmiddlelong term therapy: 69 monthsprednisone 1.52mg/kg.d48wQOD4w slowly taper Side effects of steroidnAltered glucose metabolism:hyperglycemia and glycosurianCessation of growthnCushingoid habitusnElevated blood pressurenBehavior and personality changesnHy
7、percoagulatory state,thrombosisnAdrenal insufficiencynInfectionnOsteoporosisnSome conceptsnSteroid-responsive NS:pred8w, Upro(-)nSteroid-resistant NS:pred8w, Upro(+)nSteroid-dependent NS:response to steroidtaper or discontinued+Prognosisnclosely correlated with pathologynminimal change NS : fineClin
8、ical features of the various types of pathology of NSMCNS FSGS MPGN MNAgeMale/femaleHematuriaBPSCrC3Sensitive to steriodPrognosisRecurrence after transplantation16 every age 616 1142/1 3/2 1/1 3/1A few many many manyA few some many someA few some many some- - 68%+ -93% 25% - -Good bad bad not so bad
9、- + + someDifferences between children and adults with NSchildren adults 24h Upro 50mg/kg 3.5g pathology MCNS MN etiolgy primary NS secondary NS response to steroid most well some wellcase12 years male Early morning facial edema 5 daysgeneralized edema with ascites 3 daysurine output diminished Curr
10、ent immunization Physical examinationuncomfortable-appearing obvious anasarca BP95/58mmHgperiorbital edema + breath sounds diminished heart tones normal abdomen distended fluid wave + pitting edema of the lower extremities +no rash joints normal No family history of renal disease w 15kg Urinalysis:
11、pro+ 1.030 PH 5.5 RBC - cast Urine culture: - Hemogram: normal Complement: normal ANA: - Hepatitis B surface antigen: - Albumin: 25g/L BUN: normal Cholesterol:8.9mmol/L 24-hr urine total protein:1.8g Tuberculin test : -questionsnWhat is the diagnosis?nMake differential diagnosisnHow to treat the pat
12、ient？case28 years male Early morning facial edema 5 daysgeneralized edema with ascites 3 dayscoffee-colored urine oliguria Had upper respiratory infection 2 weeks ago Current immunization Physical examinationuncomfortable-appearing BP 105/70mmHgperiorbital edema + breath sounds diminished heart tone
13、s normal abdomen distended fluid wave + pitting edema of the lower extremities +no rash joints normalNo family history of renal disease w 30kg Urinalysis: pro+ 1.030 PH 5.5 RBC + Urine culture: - Hemogram: Hb10g/L ANA: - Hepatitis B surface antigen: - Albumin: 20g/L BUN: normal Cholesterol:8.5mmol/L 24-hr urine total protein:3.0g Tuberculin test : -ASO C
