小儿肾脏疾病英文课件

PediatricRenalDiseases DevelopmentalandPhysiologicalAspects1 Urinevolume Newborns1 3ml kg h3 10d100 300ml d 2m250 400ml d 1y400 500ml d 3y500 600ml d 5y600 800ml d 8y600 1000ml d 14y800 1400ml d 14y1000 1600ml d Oliguria lowurineoutput Newborns 1ml kg hInfant infancy 200ml m2 dPre schoolage 300ml m2 dSchoolage 400ml m2 d Anuria 50ml m2 d newborns 0 5ml kg h 2 Routineurinetest2 1 Urinecolor normallyyellow colorchangesmaybenormalorabnormal2 2 PH normalrange5 72 3 Specificgravitynewborns 1 006 1 008 1yearold 1 011 1 025 2 4 Urineanalysis freshlycollectedandcentrifugalurine RBC 3 hpf WBC 5 hpf Casts cellular RBC WBC andgranularcastsareabnormal hyalinecastscanbenormal Crystals phosphateanduratecrystalsmaybenormal Protein Pro negative Sugar Glu Ketones Ket Urobilinogen Uro Bilirubin Bil 3 AddiscountRBC 50 0000 WBC 1 000 000 Casts 50004 24htotalurinaryproteinlessthan100mg m2 d or 4mg m2 h or 100mg L or 150mg d 5 Renalfunctiontests BUN Cr6 ImagingproceduresX ray Ultrasound VCUG Nuclearmedicine 99mTcDMSA 99mTcDTPA IVPetc 7 RenalBiopsy GlomerularDiseases Classify Clinicalclassify1 Primaryglomerulardiseases1 1 Glomerulonephritis Nephritis Acuteglomerulonephritis Rapidlyprogressiveglomerulo nephritis RPGN Persistentglomerulonephritis Chronicglomerulonephritis Rapidlyprogressiveglomerulo nephritis RPGN Persistentglomerulonephritis Chronicglomerulonephritis 1 2 Nephroticsyndrome NS SimpletapeNS NephritictapeNS 1 3 Asymptomatic isolated hematuriaorproteinuria1 4 Familialnephritis2 Secondaryglomerulardiseases itispartofmul tisystemdisorder e g 2 1 HepatitisBvirusrelatedglomerulonephritis HBV GN 2 2 Purpuricnephritis2 3 Lupusnephritis LN Pathologicclassify Immunopathologyclassify AcuteGlomerulonephritis AGN DefinitionGlomerulonephritisisavariousgroupofdiseases acutenephriticsyndrome Acutepoststreptococcalglomerulonephritis APSGN acutenephritis Incidenceage in5 14yearsold peakage 3 7yearsold Boys girls 2 1 Incidencepeak Jan Feb Sep andOct Etiology Pathogenesis Bacterial groupA hemolyticstreptococci Staphylococci Pneumococci G bacilli Viral influenzavirus mumpsvirus Coxsackievirus ECHOvirusandEBV Otherpathogensfungietc TheimmunoreactioncausedbygroupA hemolyticstrep tococci nephritogenicstrans Circulatingimmunecomplexes CIC Antigens antibodiesInsituimmunecomplexes depositedonglomerularcapillaries complementsystemactivated immunemediatorsandinflammatorymediators Pathology1 Thefeatureofpathologicalchanges Diffus exudativeandproliferativeinflammationoftheglomerulus 2 ChiefvarietyEndothelialandmesangialcellsproliferationwithleukocyteinfiltration immunofluorescenceshowsgranularIgG C3deposits Electronmicroscopy Hump likeelectrondensedepositsonepithelialsideofGBMPathophysiology Figure InfectionofstreptococciImmunecomplexesLocalimmuneinflammationinglomerularcapillariesStenosisofbloodGlomerularfiltrationcapillarycavitymembraneinjuryGFR HematuriaProteinuriaOliguriaCylindruriaBloodvolume Venouspressure EdemaCirculatoryload Hypertension ClinicalManifestations Prodromalinfectionspharyngitis scarletfever Angina andpyoderma Incubationperiod about10daysforpharyngitis 14 20daysforskininfection 1 Typicalfindings generalcase 1 1 Ordinarysymptoms lowgradefever nausea debility malaise anorexiaandvomiting etc 1 2Principalsymptoms nephricsigns a Edema nonpitingedema nephriticedema Edemaisthemostcommoninitialsign PeriorbitaledemaOliguriamaybepresent b HematuriaMicroscopic mostofcases 5 hpf Gross 1 3 1 2cases usuallyteaorcolacolored brownish urine continue1 2w 肉眼血尿 c Hypertension 1 3 2 3casesPre schoolage 120 80mmHgSchoolage 130 90mmHgHeadachemaybepresentd Proteinuria 3 2 Severefindings Severecase Appearthefollowingsymp tomswithin2woftheonset a CirculatorycongestionRR HR fidget hepa tomegaly dyspnea jugularphlebectasia pulmonaryedema galloprhythmandcardiacdilation ChestX ray Enlargedcardiacsilhouette lungmarkingscoarsen pulmonaryvascularcongestion b Hypertensiveencepha lopathyBP brainhypoxiaandedema Smartheadache nausea vomitinganddiplopiaortransientblindness convulsion coma Hypertensivecrisis c AcuterenalinsufficiencySevereoliguriaoranuria temporaryazotemia distur banceofelectrolytesandmetabolicacidosis 3 Atypicalfindings Atypicalcase Extrarenalsymptomaticnephritis Acutenephritiswithneph roticmanifestation AsymptomaticAGN Laboratoryinvestigations1 RoutineurinalysisRBC 2 3 5 hpf protein1 3 mayoccurhyaline orgranularorredcell casts WBC 2 Bloodexam2 1 Hemogram initialmildanemia duetohemodilution WBC ornormal2 2 ESR 3 Renalfunctions BUNandCrarenormalorslightincrease 4 ImmunologicexamEvidenceofrecentstreptococcalinfection 4 1 ASO 70 80 ofpatients 10 14daysafterinfected incidencepeakat3 5w normalafter3 6m 4 2 ADNase B positiverateishigh morethan90 cases 4 3 ADPNase4 4 Ahase 5 Serumcomplement80 90 cases lowCH50andlowC3 within2woftheonset normalizedin6 8w IfC3stilllowafter8w otheretiology Course Prognosis Course About2w Routineurinetest returnstonormalwithin4 6w ESR returnstonormal within2 3m Addiscount 4 8m Microscopichematuriamaypersistfor6m 1y Prognosis mostchildren 95 haveacompleterecover recurrencesarerare DiagnosisClinicaldiagnosis AcuteNephriticSyndrome Diagnosticpoint1 Prodromalinfections evidenceofstreptococcalinfection 2 Urineexam RBC proteinandcasts3 LowC3 DifferentialDiagnosis1 OtherAGN e g MPGN IgAnephropathy IgAN 2 Acuteexacerbationofchronicnephritis 3 RapidlyprogressiveGN4 Nephroticsyndrome5 SecondaryGN e g HSPnephritis TherapyThereisnospecifictreatmentfortypicalcases 1 Generalmeasures1 1 FrequentmeasurementofBP 1 2 ResttreatmentBedrest within2wofonsetSlightactivities edemasub sided BPbenormalandgrosshematuriadisappeared Continuetoattendschool ESRreturnstonormalNormalactivities 3maftertheroutineurinetestbenormal 1 3 Diet Edema hypertension re strictsodium lowsaltdiet sodiumchloride60mg kg d orsalt freediet Azotemia proteins0 5g kg d Severeoliguria BP orcirculatorycongestion re strictingfluidintake charttorecordintakeandoutput 2 AntibioticsObject toeradicateremnantbacteriainthefocuses butdoesnotalternaturalhistoryofAGNPGim for10 14days 3 Symptomatictreatment3 1 DiureticsHCT1 2mg kg d Lasix1 2mg kg time q6 8h prn 3 2 Antihypertensivemedica tionSystolicpressure 140mmHgDiastolicpressure 90mmHg Ni