急性肾炎ppt课件

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Treatment
Treatment strategy for AGN
1 Bed rest as necessary 2 Fluid and salt restriction
3 Specific intervention for the following Hypertention and other signs of volume overload,
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Diagnosis
Definition
Edema Hypertension
Hematuria Oliguria
Etiology is pursued with a throat swab, antistreptolysin O titre Low complement C3 level
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GBM injury
Hematuria proteinuria
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Frequency of clinical Manifestations in APSGN
Gross hematuria
25 – 33 %
Volume overload Edema Hypertension Circulatory congestion
Diagnostic renal biopsy is indicated in some circumstances as immunosupression may prevent irreversible renal failure if used early
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Nephritis strain（Ag）
CIC/IC
Diffuse proliferative
Depositing within glomeruli and stimulate the fixation of complement/antibody
GFR↓ overload
oliguria
edema hypertention
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MPorsot gpantioenstsisrecover completely
Rarely, a rapid progressive glomerulonephritis with renal failure may occuwk.baidu.com, especially in nephritis from other causes
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Pathology
In AGN, immunofluorescent studies show finely granular staining for IgG in peripheral capillary loops
and in mesangial areas
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Pathogenesis
眼血尿 ）
microscopic hematuria
（镜下血尿 ）
均一性 / 非均一性
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Pathology
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Pathology
Normal glomerulus
AGN
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Pathology
With infiltration by hematogenous cells, most notably PMNS
85% 60-80% 20%
CNS symptoms Progressive GN
10% <1%
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Evaluation to Document likelihood of typical poststreptococcal AGN
Complement: decreased during acute phase levels rise toward normal by 6-8 weeks
ESR：
rising during acute phase
levels return to normal by 2-3 months
Beginning recovery in 1 week: • Diuresis
• Blood presure normalized • BUN, cretinine begin to fall
including encephalopathy Acidemia / Hyperkalemia / Hyperphosphatemia
** Keep high index of suspicion for diseases other than APSGN ( differential doagnosis )
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Acute Nephritis 急性肾炎
Post-infectious glomerulonephritis Post-streptococcal glomerulonephritis
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Acute Nephritis
characterized by:
Fluid retention (Edema, Hypertension)
Hematuria Oliguria
Group A -hemolytic streptococci (history of infection, positive culture/ elevated antistreptolysin title)
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Cinical features
gross hematuria（肉