（内科学课件）02慢性肾小球肾炎

Chronic Glomerulonephritis Li Manli What is chronic glomerulonephritis (CGN)? Another name is chronic nephritis. A group of primary glomerular diseases characterized by hematuria, proteinuria, edema and hypertension with or without renal disfunction. slowly and insidiously progress to end-stage renal disease (ESRD). hematuria: gross hematuria and microscopic hematuria(the count of RBC in fresh urinary sediment is more than 3 per high power field under microscope) proteinuria: total 24hs protein amount is persistently more than 150mg gross hematuria Normal Why shall we learn CGN ? It is a common disease, still a main cause of uremia in our country. Doctors and patients often ignore the disease when the symptoms are very mild,leading to late diagnosis and treatment. Etiology and Pathogenesis unclear A small number due to acute post-streptococcal glomerulonephritis. Etiology and Pathogenesis Pathogenesis immune factorsimmune factors inflammation mediated byinflammation mediated by primary immunological primary immunological reactionreaction MAIN non-immune factorsnon-immune factors pphypertensionhypertension ppsevere proteinuriasevere proteinuria pp hyperlipidemia(high blood fat) pphyperuricemia(high uric acid) (etc) hyperuricemia(high uric acid) (etc) during disease processduring disease process. . pathology mesangial proliferative nephritis mesangiocapillary glomerulonephritis membranous nephropathy focal segmental glomerulosclerosis(FSGS) sclerosing glomerulonephritis Clinical manefestation edema: hypertention hypertention female at the age of 31 impaired vision ophthalmologist fundus hemorrage hypertention(160/102mmHg) cardiologist urine analysis kidney fuction hypertention hypertention hypertention Clinical manefestation edema;hypertention;gross hematuria; non-specific symptom：pain in the lumbar、fatigue chronic renal failure abnormal urine analysis without symptom Laboratory tests （1）urine analysis: hematuria，proteinuria （2）blood test: blood routine：normal or mild anemia kidney function: BUN，Cr （3）B-ultrosound：size of the kidneys normal or small （4）renal biopsy：to make pathologic diagnosis, help therapy, and prognosticate diagnosis abnormal urine analysis(proteinuria and, or hematuria),edema,hypertention with or without renal disfunction,excluding secondary and hereditary glomerulonephritis. Differential diagnosis 1.Lupus nephritis seconary to Systemic Lupus Erythematosus(SLE) What is SLE? A kind of autoimmune disease; Female more than male; Multiple system and organ involved; Specific immunological markers (ANA, anti- dsDNA antibody, anti-Sm antibody positive); Manefestaion of SLE Skin and joints: fever,baldness,oral ulcer,light sensitiveness,rash(erythema),joint pain Manefestaion of SLE Cardiovasular system(pericarditis,myocarditis) Polyserositis(hydrothorax,ascites, Pericardial effusion) Manefestaion of SLE Lung:hydrothorax,interstitial peumonia,pulmonary arterial hypertention Nervous system:seizure,headache,confusion Psychiatric system: Hematologic system: anemia,leukopenia,thrombocytopenia Digestive system: Kidney:lupus nephritis IC widely deposit in Glomerular. IgG、IgA、 IgM are positive. Case report female ,23ys erythema,mild jont pain PE: mild to moderate fever, erythema Lab tests: urine analysis:mild proteinuria blood routine:anemia, leukopenia dsDNA antibody: positive Case report Female, 33ys edema ,dypnea PE:edema,HR:105beat/min Lab tests: urine analysis:proteinuria and hematuria blood routine:anemia dsDNA antibody , anti-Sm antibody :positive cardic ultrasound: pericardial effusion Chest X-ray:hydrothorax A long history of diabetes, then urinary abnormality. Evidence of other diabetic microvascular complications :such as diabetic retinal lesions or diabetic neuropathy. Glomerular hematuria is not obvious. 2. DN（diabetic nephropathy) DN（diabetic nephropathy) secondary to primary hypertention. history of primary hypertention more than 5- 10 years; renal tubular disfunction occurs earlier than glomerular injury; mild proteinuria; complicated with heart and brain injury 3.Benign arteriolar nephrosclerosis caused by allergic purpura high incidence in children. symmetrical purpura (the four limbs ) hematuria , different levels of proteinuria joint pain abdominal pain and bloody stool 4. Purpura nephritis Recurrent urinary tract infection history; Urine bacteriological examination often positive; Imageology examination : double kidney asymmetric shrink. 5. Chronic pyelonephritis 6. Alport syndrome positive family history ,more onset in adolescent (1 g/d) Symptomatic treatment control infection eliminate edema decrease proteinuria:glucocorticoid and immunosuppressive agent Avoid aggravating factors: keep away from infection,renal toxic medicine(some Chinese medicine,antibiotics,contrast agent,NSAID) prognosis Progress slowly and continuous