血尿蛋白尿鉴别定稿.pptxVIP

内 容;血尿的诊断思路;颜 色;试纸法检测：潜 血; 假阳性;血尿的定义;尿检阳性是血尿吗？;确定是否是真性血尿;血尿的诊断步骤;判断出血的部位（1）;判断出血的部位（2）;肾单位血尿;判断出血的部位（3）;血尿的诊断步骤;确定病变性质（1）;1.肾单位来源(内科性):  原发、继发、家族性 2.非肾单位来源(外科性): 肿瘤、外伤、结石、畸形、血管等;内科性血尿查什麽?;内科性血尿;外科性血尿查什麽?;外科性血尿;胡桃夹子现象;内 容;正常尿蛋白;失去大小选择性屏障 理论上GBM滤过孔孔径加大，长度缩短 单位面积GBM上孔密度增加 以上两项均有 失去电荷选择性屏障 GBM失去带阴电荷的分子(糖蛋白分解增加/合成减少) 带阳电荷的分子中阴电荷 以上两项均有 ;肾小球滤过屏障;蛋白尿的分类和特点;诊断思路;内 容;诊断层次;诊断方法及程序;排除假性血尿 血凝块 血尿中混血凝块常提示非肾小球疾患出血 血尿与全身疾病及呼吸道感染的时间关系 PSGN：感染后10－14天出现血尿 IgAN： 几乎同时发生，一般不超过3天。 家族史:耳聋、血尿、肾衰 血尿伴随症状 肾绞痛 尿路刺激症 水肿、高血压及全身其他症状等;Onset when began with conditions identified around the initial presentation, i.e., drug ingestion record of previous urinalyses precipitation/palliation identification of triggering agents infectious, drugs, foods, chemicals, vaccinations helps to identify acquired forms of tubulointerstitial proteinuria ;quality associated with hematuria severity ： pathologic if associated with hematuria or Nephrotic Syndrome  likely to be a primary GN unlikely to be benign etiology or secondary GN timing acute vs acute-on-chronic intermittent vs persistent duration of proteinuria ;associated symptoms past medical history functional inquiry Specific Entities helps to differentiate acute GN from chronic GN identify overload proteinuria causes ;1. History of Presenting Illness;病史;2. Family History;PE? Lab? More information……;3 Physical Examination;Glomerular Proteinuria;进一步检查;病因诊断;病理诊断;随 访;CASE 1;Important questions to ask in your History 1;Important questions to ask in your History 2;According to the parents, the child was treated with Bacitracin（杆菌肽） 2 weeks ago for impetigo（脓疱病 ）on the legs and arms? ;Physical Examination Findings and Associated Causes of Hematuria ;The patients examination was normal except for a blood pressure of 125/90 and some mild periorbital edema.? ;拟诊：最可能？ 其次？;拟诊：可能;进一步检查证实？;进一步检查