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1、Pediatric Renal Diseases,站,Developmental and Physiological Aspects 1. Urine volume: Newborns 13 ml/kg/h 310 d 100300 ml/d 2 m 250400 ml/d 1 y 400500 ml/d,3 y 500600 ml/d 5 y 600800 ml/d 8 y 6001000 ml/d 14 y 8001400 ml/d 14 y 10001600 ml/d,Oliguria (low urine output): Newborns 1ml/kg/h Infant & infa
2、ncy 200ml/m2/d Pre-school age 300ml/m2/d School age 400ml/m2/d Anuria: 50 ml/m2/d (newborns 0.5 ml/kg/h),2. Routine urine test 2.1. Urine color-normally yellow, color changes may be normal or abnormal 2.2. PH: normal range 57 2.3. Specific gravity newborns 1.0061.008 , 1 year old 1.0111.025,2.4. Uri
3、ne analysis freshly collected and centrifugal urine RBC 3/hpf WBC 5/hpf Castscellular (RBC, WBC) and granular casts are abnormal, hyaline casts can be normal, Crystals phosphate and urate crystals may be normal Protein(Pro) negative Sugar (Glu) Ketones (Ket) Urobilinogen (Uro) Bilirubin (Bil),3. Add
4、is count RBC 50,0000, WBC 1,000,000, Casts 5000 4. 24h total urinary protein less than 100 mg/m2/d, or 4 mg/m2/h, or 100 mg/L, or 150 mg/d,5. Renal function tests: BUN, Cr 6. Imaging procedures X-ray, Ultrasound, VCUG, Nuclear medicine (99mTc DMSA, 99mTc DTPA), IVP etc. 7. Renal Biopsy,Glomerular Di
5、seases,Classify Clinical classify 1. Primary glomerular diseases 1.1. Glomerulonephritis (Nephritis) Acute glomerulonephritis,Rapidly progressive glomerulo- nephritis (RPGN) Persistent glomerulonephritis Chronic glomerulonephritis,Rapidly progressive glomerulo- nephritis (RPGN) Persistent glomerulon
6、ephritis Chronic glomerulonephritis,1.2. Nephrotic syndrome (NS) Simple tape NS Nephritic tape NS,1.3. Asymptomatic (isolated) hematuria or proteinuria 1.4. Familial nephritis 2. Secondary glomerular diseases it is part of mul- tisystem disorder, e.g. ,2.1. Hepatitis B virus related glomerulonephrit
7、is (HBV-GN) 2.2. Purpuric nephritis 2.3. Lupus nephritis (LN) Pathologic classify Immunopathology classify,Acute Glomerulonephritis (AGN),Definition Glomerulonephritis is a various group of diseases acute nephritic syndrome. Acute poststreptococcal glomerulonephritis, APSGN (acute nephritis), Incide
8、nce age: in 5 14 years old peak age: 37 years old Boys girls = 2:1 Incidence peak: Jan. Feb. Sep. and Oct.,Etiology & Pathogenesis Bacterial: group A- hemolytic streptococci, Staphylococci, Pneumococci, G bacilli, Viral: influenza virus, mumps virus , Coxsackie virus, ECHO virus and EBV Other pathog
9、ens fungi etc.,The immunoreaction caused by group A- hemolytic strep- tococcinephritogenic strans,Circulating immunecomplexes (CIC) Antigens+antibodies In situ immunecomplexes,deposited on glomerular capillaries complement system activatedimmune mediators and inflammatory mediators,Pathology 1. The
10、feature of pathological changes: Diffus, exudative and proliferative inflammation of the glomerulus,2. Chief variety Endothelial and mesangial cells proliferation with leukocyte infiltration; immunofluorescence shows granular IgG & C3 deposits,Electron microscopy Hump-like electron dense deposits on
11、 epithelial side of GBM Pathophysiology (Figure),Infection of streptococci Immune complexes Local immune inflammation in glomerular capillaries Stenosis of blood Glomerular filtration capillary cavity membrane injury GFR Hematuria Proteinuria Oliguria Cylindruria Blood volume Venous pressure Edema C
12、irculatory load Hypertension,Clinical Manifestations Prodromal infections pharyngitis, scarlet fever, Angina, and pyoderma Incubation period: about 10 days for pharyngitis, 1420 days for skin infection,1. Typical findings (general case) 1.1. Ordinary symptoms: low grade fever, nausea, debility, mala
13、ise, anorexia and vomiting, etc.,1.2 Principal symptoms (nephric signs) a. Edema (nonpiting edema, nephritic edema) Edema is the most common initial sign Periorbital edema Oliguria may be present,b. Hematuria Microscopic (most of cases) 5/hpf, Gross (1/31/2 cases) usually tea or cola colored (brownish) urine, continue 12 w,站,肉眼血尿,c.Hypertension: 1/32/3 cases Pre-school age120/80mmHg School age130/90 mmHg Headache may be present d. Proteinuria: 3+,2. Severe findings (Sever
