急性肾小球肾炎(全英班)

Cell Proliferation
blood coagulation system (thrombus)
complement system(C3)
leukocytes (release) Damage GBM
hematuria proteinuria
GFR↓ Retenion of water and Natrium Blood Volume overload oliguria
Early school >130/90
Clinical manifestation
Laboratory examination Routine urine examination

Red blood cell ++～++++ Red cast Proteinuria +～+++，
Clinical manifestation
Epidemiology of AGN
Acute on set
Prevail in children in 3-12,especialy in
school age population,seldom seen in children below 2. Morbidity ratio of M:F is 1.5~2.5:1
Clinical manifestation
Medical
history
Streptococccal infection 1-3 weeks before onset
Clinical manifestation
Symptoms
and signs
Edema
unpitting Face and eyelid
Pathogenesis of AGN in western medicine
Etiology
Group
A β -hemolytic streptococci
AGN
Pathogenesis
circulation immune complexes Inflammation of kidney
Group A β-hemolytic streptococci （Ag）
Clinical manifestation
Symptoms
and signs Oliguria
1～2 weeks
year <1 1-3 4-6 7-14
normal
oliguria
anuria
400-500 500-600 600-800 800-1400
<200 <200 <300 <400 <30-50
(ml)
Clinical manifestation
Symptoms
anห้องสมุดไป่ตู้ signs
Microscopic hematuria
Gross hematuria
Clinical manifestation
Symptoms
and signs
Hypertension
（1）30%-80% cases。 （2）resolves within 1-2 weeks accopany with increasing of amount of urine （3）if very high，be careful of encephalic disease blood pressure （mmHg） preschool >120/80
Laboratory examination
ASO
An antibody to streptococcal antigen


Positive rate 50%～80%
Afer infection,ASO titter begin to increase within 2-3 weeks,the summit is within 3-5weeks ,then decrease slowly in 3-6 months , recovery time in 1 year.

Main symptoms and signs :
sudden onset edema:limbs and body , dark and scanty urine skin sore,fever,thirst,dysphoria chest distress,thoracic fullness poor appetite,nausea red tongue,yellow and thin fur slippery and rapid pusle
Therapeutic methods :
Dispelling wind and inducing diuresis
Prescription and drugs:
Modified mahuang Liaoqiao chixiaodou decocotion
Internal invasion of dampness and heat
Description of ancient doctor of TCM
《灵枢 · 肿胀篇》:
Shuizhong in TCM (edema) start from eyelid,mild eyelid edema as if one just get up,rapid pulse in neck, intermittent cough,cold feeling between perineum and thigh, edema in anterior tibial site and feet,enlarged abdomen,nopitting as if water in it.
Deteriorate syndrome
Water
and qi disturbing the heart and lung Pathogenic factors invading Jueyin Internal obstruction of water and toxin supplementary explanation: can be seen at the early stage
Syndrome differentiation and treatment
Sthenia , Eliminating first
Common syndromes
Wind
and water struggling with each other Internal invasion of dampness Qi deficiency of lung and spleen supplementary explanation: the first two syndromes can be seen at the early stage of AGN, while qi deficiency of lung and spleen can be seen at the late stage.
Internal ：congenital weak physique / acquired weak constitution
Questions
Metabolism
of water in TCM Oppinion :Tree abundunce and two insufficiency
Pathogenesis of AGN in TCM
Pathogenesis
LUNG
SPLEEN
KIDNEY
E T I O G Y
Dredge water passage
Water and dampness Transportation/distribution accumulated in the skin water and muscle Giving rise Transformation of qi to edema Water metabolism
Acute Glomerulonephritis
Pediatric dept of TCM hospital of Guangdong Province
Content
Familiar
with Epidemiology Familiar with Diagnosis Master Differentiation of syndrome and treatment
Clinical manifestation
Laboratory examination
80 ～ 90% ， Serum
Cз decrease within 2 weeks . is very important to differentiate between AGN and other types
Pathology of AGN
Pathology
AGN
PATHOLOGY
PASM-HE染色 ×400 正常
PASM染色 ×100 ECPGN
Etiology of AGN in TCM
Summary Exogenous ：wind /dampness /sore infection
Pathogenic factor
Common syndromes
Wind and water struggling with each other

Main symptoms and signs :
sudden onset edema:limbs and eyelids lustrous skin,unpitting edema, dark and scanty urine fever,aversion to cold cough whitish and thin fur floating/ tight or rapid pusle
C3
recovery after 6-8 weeks Cз determination
Severe condition
acute congestive heart failure hypertensive encephalic disease acute kidney failure
Epidemiology of AGN
Morbidity is highest in renal and urogenital disorder
Survey to 6,947 inpatients with renal and urogenital disorder 60 50 40 percent 30 20 10 0 AGN HSPGN 遗传性肾炎 constituent of renal and urogenital disorder in 108 hospitals

early stag（ in 2 weeks） Emergency，need rescue
Essentials for dignosis
Medical
history: streptococcal infection like URI or skin infection with in 1-3 weeks Clinical manifestation: edema,oliguria,hematuria, hypertension Lab ：C3 decrease , ASO increase
Edema
Hypertension
Etiology and Pathogenesis of AGN in western medicine
Pathogenesis Inflammation of kidney due to circulation immune complexes Medical history： upper respiratory tract infection： 1~2weeks before， winter and spring； skin infection ：2~3 weeks before,summer and autum
Description of western medicine
Edema
Hypertension
hematuria
Definition of AGN
Acute
onset A disorder of a group of glomeruli due to different causes Clinical manifestation: hematuria,edema,proteinuria,hypertension