常见的急性肾炎.ppt

Acute Nephritis急性肾炎 Post-infectious glomerulonephritis Post-streptococcal glomerulonephritis Acute Nephritis characterized by: Fluid retention (Edema, Hypertension) Hematuria Oliguria Group A ?-hemolytic streptococci (history of infection, positive culture/ elevated antistreptolysin title) gross hematuria（肉眼血尿 ） microscopic hematuria （镜下血尿 ） Cinical features 均一性 / 非均一性 Pathology Normal glomerulus AGN Pathology Pathology With infiltration by hematogenous cells, most notably PMNS Pathology In AGN, immunofluorescent studies show finely granular staining for IgG in peripheral capillary loops and in mesangial areas Pathogenesis Nephritis strain（Ag） CIC/IC Depositing within glomeruli and stimulate the fixation of complement/antibody Diffuse proliferative GBM injury GFR↓ oliguria overload edema hypertention Hematuria proteinuria Frequency of clinical Manifestations in APSGN Gross hematuria 25 – 33 % Volume overload Edema 85% Hypertension 60-80% Circulatory congestion 20% CNS symptoms 10% Progressive GN 1% 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 Diagnosis Definition Edema Hypertension Hematuria Oliguria Etiology is pursued with a throat swab, antistreptolysin O titre Low complement C3 level Treatment Treatment strategy for AGN Bed rest as necessary Fluid and salt restriction Specific intervention for the following Hypertention and other signs of volume overload, including encephalopathy Acidemia / Hyperkalemia / Hyperphosphatemia ** Keep high index of suspicion for diseases other than APSGN ( d