急性肾小球肾炎（全英班）概要课件

Acute Glomerulonephritis Pediatric dept of TCM hospital of Guangdong Province Content vFamiliar with Epidemiology vFamiliar with Diagnosis vMaster Differentiation of syndrome and treatment 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. Description of western medicine Edema Hypertension hematuria Definition of AGN vAcute onset vA disorder of a group of glomeruli due to different causes vClinical manifestation: hematuria,edema,proteinuria,hypertension Epidemiology of AGN Morbidity is highest in renal and urogenital disorder Epidemiology of AGN vAcute on set vPrevail in children in 3-12,especialy in school age population,seldom seen in children below 2. vMorbidity ratio of M:F is 1.52.5:1 Pathogenesis of AGN in western medicine vGroup A -hemolytic streptococci Etiology AGNAGNPathogenesis Group A -hemolytic streptococci （AgAg） circulation immune complexescirculation immune complexes leukocytes (release) leukocytes (release) Damage GBMDamage GBM GFRGFR Retenion of water Retenion of water and Natriumand Natrium oliguriaoliguria Blood Volume Blood Volume overloadoverload EdemaEdema HypertensionHypertension hematuria hematuria proteinuriaproteinuria complement complement system(C3)system(C3) Inflammation of kidney Inflammation of kidney blood blood coagulation coagulation system system ( ( thrombus)thrombus) Cell ProliferationCell Proliferation Etiology and Pathogenesis of AGN in western medicine Medical history： upper respiratory tract infection： 12weeks before， winter and spring； skin infection ：23 weeks before,summer and autum Pathogenesis Inflammation of kidney Inflammation of kidney due to circulation immune due to circulation immune complexescomplexes Pathology of AGN PathologyPathology AGN AGN PATHOLOGYPATHOLOGY PASM-HEPASM-HE染色染色 400 400 正常正常 PASMPASM染色染色 100 ECPGN100 ECPGN Etiology of AGN in TCM Summary Exogenous ：wind /dampness /sore infection Internal ：congenital weak physique / acquired weak constitution Pathogenic factor Questions vMetabolism of water in TCM vOppinion :Tree abundunce and two insufficiency Pathogenesis of AGN in TCM Pathogenesis E T I O G Y Dredge water passage Transportation/distribution water Transformation of qi Water metabolism Water and dampness accumulated in the skin and muscle Giving rise to edema LUNG SPLEEN KIDNEY Clinical manifestation vMedical history Streptococccal infection 1-3 weeks before onset Clinical manifestation vSymptoms and signs Edema unpitting Face and eyelid Clinical manifestation vSymptoms and signs Oliguria yearyear normalnormal oliguria oliguria anuriaanuria 120/80 120/80 Early schoolEarly school 130/90 130/90 （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 Clinical manifestation vRed blood cell + vRed cast vProteinuria +， Routine urine examination Laboratory examination Clinical manifestation ASO Laboratory examination v Positive rate 50%80% vAfer 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. An antibody to streptococcal antigen Clinical manifestation C3 Laboratory examination v 8090%，Serum C decrease within 2 weeks . v recovery after 6-8 weeks vCdetermination is very important to differentiate between AGN and other types Severe condition v acute congestive heart failure v hypertensive encephalic disease v acute kidney failure early stag（ in 2 weeks） Emergency，need rescue Essentials for dignosis vMedical history: streptococcal infection like URI or skin infection with in 1-3 weeks vClinical manifestation: edema,oliguria,hematuria, hypertension vLab ：C3 decrease , ASO increase Syndrome differentiation and treatment Sthenia , Eliminating first Common syndromes vWind and water struggling with each other vInternal invasion of dampness vQi 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. Deteriorate syndrome vWater and qi disturbing the heart and lung vPathogenic factors invading Jueyin vInternal obstruction of water and toxin supplementary explanation: can be seen at the early stage Common syndromes Wind and water struggling with each other vMain 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 Therapeutic methods : Dispelling wind and inducing diuresis Prescription and drugs: Modified mahuang Liaoqiao chixiaodou decocotion Internal invasion of dampness and heat vMain 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 : Clearing away heat and Moving toxin,removing dampness to relieve edema Prescription and drugs: Sanmiao pill in combination with daochi power Qi deficiency of the lung and spleen vMain symptoms and signs : be seen in late stage inapparent edema or no, disappearance of hematuria profuse sweat lustreless or pale complexion lassitude,hypodynamia pale tongue with whitish fur slow and weak pusle Therapeutic methods : Strengthening the spleen Supplementing qi Prescription and drugs: Modified shenling baizhu power In combination with yupinfen power Water and qi superiorly disturbing the heart vMain symptoms and signs : be seen in early stage edema:limbs and body , cough with short breath, palpitation,chest distress cyanotic lips ,dysphoria inability to lie flat whitish and greasy fur rapid pusle without force Therapeutic methods : Purging the lung and expelling water,warming yang and enhence body resistance Prescription and drugs: Modified jijiao lihuang pill Pathogenic factors invading jueyin meridian vMain symptoms and signs : be seen in early stage headache,vertigo blur vision,dysphoria accidental syncope clonic convulsion red tongue,yellow and rough fur taut pusle Therapeutic methods : Clearing away heat Calming the liver Suppressing yang Purging fire and heat Prescription and drugs: Modified longdan xiegan decoction Internal stagnation of water and toxin vMain symptoms and signs : be seen in early stage general edema , scanty urine or anuria dizziness,headache, nausea,vomiting,even coma greasy fur and taut pusle Therapeutic methods : Expelling the exterior