NicetomeetyouNicetomeetyou1AcuteGlomerulonephritis

BeijingChildren’sHospitalaffiliatedtoCapitalUniversityofMedicalSciencesMengQunAcuteGlomerulonephritis

Beiji2AcuteGlomerulonephritisDefinitionEtiologyandPathogenesisPathologyClinicalfeaturesLaboratoryfindingsDiagnosisanddifferentialdiagnosisTreatmentAcuteGlomerulonephritisDefini3Definition

acuteonsetpostinfectiousglomerulonephritis:pharyngitisorpyodermaoftenbelongtoacutepoststreptococcalglomerulonephritis(APSGN)resultofinflammatoryglomerularinjuryDefinition

acuteonset4

Definitionhematuriaproteinuriaedemahypertensionrenalinsufficiency

Definitionhematuria5

commonage:5~14y<2y:raremale/female≈2/1self-limitedprognosis:finemorbidity:onthedecline

6

Etiologybacteria,viruses,mycoplasma…groupAβ-hemolyticstreptococcitype12:pharyngitistypes2,49,50,55,60:pyodermatype49:pharyngitisorpyoderma

Etiologybacteria,viruses,7Pathogenesis

secondarytoadirecttoxiceffectontheglomerulusofastreptococcalproteinthestreptococcalproductinduceanimmunecomplex-mediatedinjury

1)introducinganantigentotheglomrulus:plantedantigen2)depositionofcirculatingimmunecomplexes3)alteringanormalrenalantigentoaself-antigeninducinganautoimmuneresponsetotheself-antigen

Pathogenesissecondarytoadi8streptococcalantigenCICinsituICtriggerautoimmunitycomplementactivitedinflammatoryglomerularinjuryGBMdamagedhematuriaproteinuria

proliferativemesangialandendothelialcellsGFRoliguria,edema,hypertentionstreptococcalantigenCICinsit9Pathology

diffuseglobalhypercellularityproliferativemesangialandendothelialcellscrescentformationsubepithelialdepositioninterstitialedemainterstitialinfiltrationofleukocytePathology

diffuseglobalhyper10Clinicalfeatures

presentfromasymptomatictooliguricacuterenalfailurelatentperiod:afterpharyngitis:6~12daysafterskininfection:14~28daysClinicalfeatures

presentfrom11Nonspecificsymptomsandsigns

tirednessheadacheappetiteslightlyfevervomiting…

thesignofinfectionNonspecificsymptomsandsigns12Classicalmanifestation(1)

hematuria

grosshematuria:50~70%patientscoffee-coloredortea-coloredturntomicrohematuria:after1~2wClassicalmanifestation(1)

hem13Classicalmanifestation(2)edema:70%patientsreason:sodiumandfluidretentionpresents:faceperiorbitalupperextremitiesClassicalmanifestation(2)edem14腎炎腎病幻燈課件15Classicalmanifestation(3)hypertention:30~80%patientsmildtomoderate

schoolagepatients≥130/90mmHgpre-schoolagepatients≥120/80mmHgClassicalmanifestation(3)hype16Classicalmanifestation(4)proteinuria:theextentisvariousmost<3g/dnephrotic-rangeproteinuria:20%patientsurinevolume:Classicalmanifestation(4)prot17Severecase(1)

severehypervolemia:oftenoccurs<1weekoftheonsetofAGNcausedbysodiumandfluidretention

manifestations:dyspneacoughsevereedemaenlargedheartandliver…Severecase(1)

severehypervo18Severecase(2)hypertensiveencephalopathy:intheearlyonsetofAGNBP>150~160/100~110mmHgreason:CNSvasculitismanifestations:headachevomitingconfusionsomnolenceconvulsioncoma

Severecase(2)hypertensiveenc19Severecase(3)acuterenalfailure:last3~5d,<10dmesangialandendothelialcellsproliferationbloodvolumeofcapillaryglomerularfiltrationrate(GFR)Severecase(3)acuterenalfail20Non-Classicalmanifestation(1)

asymptomaticAGN:microhematuriawithoutotherclinicalmanifestation

contactingAGNpatientsorwhenstreptococciisepidemicNon-Classicalmanifestation(121Non-Classicalmanifestation(2)extrarenalAGN:edemahypertentionC3

ASOurinetest:nomalorslightlyabnomalNon-Classicalmanifestation(222Non-Classicalmanifestation(3)nephroticsyndromelikeAGN:severeedemahematuriaproteinuriahypoalbuminimiahypercolesteralimia

Non-Classicalmanifestation(323Laboratoryfindings(1)urine:dysmorphicredbloodcellredbloodcellcastscastsofleukocytesrenaltubuleepithelialcellshyalineandgranularcastsproteinuriaLaboratoryfindings(1)urine:24erythrocytesedimentationrate:antistreptolysinO(ASO):pharyngitis10~14daysofphasereachthehightesttiterin3~5weeks,returntonomalin3~6monthantideoxyribonucleaseB(+):pyodermaLaboratoryfindings(2)erythrocytesedimentationrate25complement:returntonormal<8weekscirculationgimmunecomplexes:(+)BUN,Cr:correlatewithdiseaseactivityLaboratoryfindings(3)complement:Laboratoryfindin26Diagnosisacuteonset+abnomalurinetestoredema,oliguria,hypertentionAPSGN:above+streptococcalinfectialdisease+increasedASO+decreasedC3Diagnosisacuteonset+abnomal27Differentialdiagnosis(1)

AGNcausedbyotheretiologiesandpathogenicmechanisms:suchasvirusesDifferentialdiagnosis(1)28Differentialdiagnosis(2)IgAnephropathy

latent:24-48hnoedema,hypertentionC3:normalDifferentialdiagnosis(2)IgAn29Differentialdiagnosis(3)ChronicGNwithacuteepisode:

latent:short(1~2days)patients:malnutritionanemiagrowthretardedrenalfunction:usuallyabnormalproteinuria:severegravityofurine:Differentialdiagnosis(3)Chron30Differentialdiagnosis(4)Idiopathicnephroticsyndrome:

ASO:normalPathology

Differentialdiagnosis(4)Idiop31Differentialdiagnosis(5)rapidlyprogressiveglomerulonephritis(crescenticglomerulonephritis)

oliguriaoranuriarapidlossofrenalfuntionsecondaryGN:LupusnephritisPurpuranephritisHBV-associatedglomerulonephritis

Differentialdiagnosis(5)rapid32Treatment

nospecifictreatmentsupportivecare

Treatmentnospecifictreatmen33Generaltreatment

stayinbed:2~3weekssaltintake:60mg/Kg.dlimitproteinintake:0.5g/Kg.d(azotemiaperiod)Generaltreatmentstayinbed34Appropriateantibiotictherapy

penicillinG:10~14days

otherantibiotics:

accordingtosensitivitytestAppropriateantibiotictherapy35

Othertreatment

Edema:controlliquidandsaltdiureticsHypertention:rest,controlliquidandsaltNifedipineCaptoprilOthertreatment

Edema:cont36Treatmentofseverecases(1)

Severehypervolemia:restricttheintakeofliquidandsaltloopdiuretics:furosemidesodiumnitroprussidedialyticsupportTreatmentofseverecases(1)S37Hypertensiveencephalopathy:

sodiumnitroprusside

controlconvulsionAcuterenalfailure:

comprehensivetherapyTreatmentofseverecases(2)

Hypertensiveencephalopathy:T38Prognosisandprevention

recovery:95%severecasesmayprogressedtochronicGNandCRFprevention:preventinfectionPrognosisandprevention

recov39NephroticSyndrome

NephroticSyndrome

40Definition(NS)

massiveproteinuriahypoproteinemiaedemahyperlipidemiaDefinition(NS)

massiveprot41mayoccurasaresultofanyformofglomerulardiseasemaybeassociatedwithavarietyofextrarenalconditionsaccordingtoetiology:primaryNS:simpleandnephritictypeNSsecondaryNScongenitalNSmayoccurasaresultofanyf42usuallyaffectspre-schoolchildrenthemostcommonage:3~5yearsmale/female≈3.7/1mostcommonformofnephropathyusuallyaffectspre-schoolchi43racialandgenomicandenviromentalbackground:nephrin--NPHS1,podocin…steroidresponsiveNS:

associatewithHLA-DR7frequentlyrelapse:

correlatewithHLA-DR9steroidresistantNS:NPHS2

racialandgenomicandenvirom44EtiologyandPathogenesis

unclear

thechangeofformationandelectronofcapillaryglomerularpermeabilitytoproteinEtiologyandPathogenesisuncl45minimalchangeNS:noimmunecomplexdepositionnegativechargeofbarrier:injury(cell-mediatedimmunity)non-minimalchangeNS:Igand/orCdepositatglomerrulidamagethefiltratedbarrierminimalchangeNS:46Physiopathology

Proteinuria:

themostbasicclinicalcharacterthefusionoffootprocessesofthevisceralepitheliumofGBMthenegativechargeglomrularpermeabilitytoproteinPhysiopathologyProteinuria:47Hypoproteinemiareason:thelossofalbumininurinesynthesisofalbuminnoproperintakingproteinserumalbuminisnegativelycorrelatedwiththeseverityofproteinuriaHypoproteinemiareason:48Edema

themostcommonsymptoms:1)hypoproteinemiaplasmaoncoticpressurehypovolemia2)serumalbumin<25g/Lfluidintotheinterstitialspace<15g/Lasites3)tubularsodiumreabsorption4)thedefectofNaarrangement5)serumADHEdemathemostcommonsympto49腎炎腎病幻燈課件50Hyperlipidemiahypercholesterolemiahypertriglyceridemiasynthesislow-densitylipoproteinscatabolismverylowdensitylipoproteinsdamagevasculatureinduceglomerulosclerosiscorrelatedwithhypoalbuminemiaproteinuriaHyperlipidemiahypercholeste51PathologyminimalchangeNS:76.4%membranoproliferativeGN:7.5%focalsegmentalglomerulosclerosis:6.9%mesangialproliferativeGN:2.3%focalglomerulosclerosis:1.7%membranousnephropathy:1.5%…………Pathology52MCNS:LightMicroscopynoglomerularlesionsminimalfocalsegmentalmesangialprominencethematrix:noexpandedtotheextentthatcapillarylumensarecompromisedcapillarywalls:thinandcapillarylumenspatentproteinandlipidresorptiondropletsintubularepithelialcellinterstitialedema:rareMCNS:LightMicroscopy53MCNS:

ElectronMicroscopytheeffacementofvisceralepithelialcellfootprocessesmicrovilloustransformationglomerularandproximaltubularepithelialcellshaveincreasedclearanddensecytoplasmicdropletsMCNS:ElectronMicroscopythee54MCNS:ImmunofluoresensesMicroscopynoremarkablefindingslow-levelmesangialstainingforIgMMCNS:ImmunofluoresensesMicro55membranoproliferativeGNmembranoproliferativeGN56mesangialproliferativeGNmesangialproliferativeGN57membranousnephropathymembranousnephropathy58ClinicalManifestation(1)

cardinalclinicalfeature:abruptonsetofedemaheavyproteinuriahypoalbuminemiahyperlipidemiaClinicalManifestation(1)card59ClinicalManifestation(2)hematuria:unusualhypertention:notcommontransientGFR:30%patientscausedbyhypovolemiathefunctionofrenal:nomalARF:rareClinicalManifestation(2)hemat60ComplicationsInfectionsElectrolitedisturbanceandhypovolemiaHypercoagulabilityandthrombosisAcuterenalfailureTubularfunctionlesionGrowthretardedComplications61Laboratoryfindingsurineanalysis:

proteinuria:≥40mg/h.m2

or≥50mg/kg.dUpro/Ucr≥3.5microscopichematuria:<15%patientshyalineandgranularcastsLaboratoryfindingsurineanal62erythrocytesedimentationrate:serumalbuminconcentration:totalcholesteral,LDL,triglyceride:serumcomplement:usuallynormalothers:plasmaviscosityRBCaggregation,PLT,fibrinogenplasminogenandantithrombinIIIrenalfunction:usuallynormalLaboratoryfindingserythrocytesedimentationrate63Diagnosis(simpletypeNS)

proteinuria:+++~++++≥40mg/h.m2or≥50mg/kg.d

hypoproteinemia

ALB＜30/L

hyperlipidemia:

TC>5.72mmol/Lor220mg/dl

edemaDiagnosis(simpletypeNS)pr64Differentialdiagnosis(1)

NephritictypeNS

abovepoints+atleast?asfollowsurinetest:dysmorphicredbloodcellRBC>10/HP>3times2weekshypertention:schoolagechildren≥130/90mmHgpre-schoolagechildren≥120/80mmHgrenalfunctioninsufficiencypersistentcomplementDifferentialdiagnosis(1)65SecondaryNS:

APSGNLupusnephritisPurpuranephritisHBV-associatedglomerulonephritis…Differentialdiagnosis(2)

SecondaryNS:Differentialdia66Treatment:Generaltreatment

restinbeddietary:salt1~2g/dhighqualityprotein1.5~2g/kg.dVitD400u/d,Casevereedemaandhypertension:

limitliquidandsaltantihypertensiondiureticscontrolandpreventinfectionknowledgeeducation

Treatment:Generaltreatment67CorticosteroidtherapyPrednisone:2mg/kg.dmaximum60mg/dprinciple:

enoughdosageslowlytaperlongremainVitD,CalciumCorticosteroidtherapyPredniso68Newpatients:

shorttermtherapy:8weeksprednisone2mg/kg.d×4w1.5mg/kg.qod×4wmiddle~longtermtherapy:6~9monthsprednisone1.5~2mg/kg.d×4~8wQOD×4wslowlytaper

Newpatients:

shorttermthera69SideeffectsofsteroidAlteredglucosemetabolism:hyperglycemiaandglycosuriaCessationofgrowthCushingoidhabitusElevatedbloodpressureBehaviorandpersonalitychangesHypercoagulatorystate,thrombosisAdrenalinsufficiencyInfectionOsteoporosis…………SideeffectsofsteroidAltered70SomeconceptsSteroid-responsiveNS:pred≤8w,Upro(-)Steroid-resistantNS:pred≥8w,Upro(+)Steroid-dependentNS:responsetosteroidtaperordiscontinued<1month,relapse≥2timesRelapse:Upro(-)Upro(+)＞2wFrequentlyrelapse:＜6monrelapse≥2times＜1yearrelapse≥3timesSomeconceptsSteroid-responsiv71Frequentlyrelapseor

steroiddependentpatients:

adjustthesteroiddosageadjustperiodofsteroidchangetoothersteroid:dexamethasonemethylprednisoloneFrequentlyrelapseor

steroid72Immunosuppressivetherapy

frequentlyrelapsesteroiddependentsteroidresistantserioussideeffectswithsteroidtherapyCyclophosphamide,cyclosporinA,…Immunosuppressivetherapyfreq73Cyclophosphamide2~2.5mg/kg.dTidpo×8~12w＜200mg/kg10~12mg/kg.div×2d/2w＜150mg/kg500mg/m2iv/mon×6~8m＜200mg/kgSideeffects:bonemarrowsuppression(WBCPLT)liverfunctionhemorrhagiccystitisgonadaldysfunctionCyclophosphamide2~2.5mg/kg.d74Anticoagulant

SodiumHeparin:1mg/kg.d2~4weeksivUrikinase:3~60000u/d1~2weeksivDipyridamole:5~10mg/kg.dpoTid×6mAnticoagulant

SodiumHeparin75Enhanceimmunefunction

Levamisole:2.5mg/kg,dQod×6mImmunogloblin:400mg/kg.d×5daysEnhanceimmunefunction

Levami76Angiotensinconvertingenzymeinhibitor

(ACEI)CaptoprilEnalaprilFosinoprilTraditionalherbs

OthersAngiotensinconvertingenzyme77Criteriaofrecoveryclinicalcured:

stoptreatmentfor3yearstotalremissionnorelapsetotalremission:laboratorytestisnomal.partremission:proteinuria<+++noremission:proteinuria>+++Criteriaofrecoveryclinicalc78PrognosiscloselycorrelatedwithpathologyminimalchangeNS:finePrognosis79ClinicalfeaturesofthevarioustypesofpathologyofNSMCNSFSGSMPGNMNAgeMale/femaleHematuriaBPSCrC3SensitivetosteriodPrognosisRecurrenceaftertransplantation1~6everyage6~161~142/13/21/13/1AfewmanymanymanyAfewsomemanysomeAfewsomemanysome--68%+-93%25%--Goodbadbadnotsobad-++someClinicalfeaturesofthevario80DifferencesbetweenchildrenandadultswithNS

childrenadults24hUpro>50mg/kg>3.5gpathologyMCNSMNetiolgyprimaryNSsecondaryNSresponsetosteroidmostwellsomewellDifferencesbetweenchildrena81case12yearsmaleEarlymorningfacialedema×5daysgeneralizededemawithascites×3daysurineoutputdiminishedCurrentimmunizationPhysicalexaminationuncomfortable-appearingobviousanasarcaBP95/58mmHgperiorbitaledema++breathsoundsdiminishedhearttonesnormalabdomendistendedfluidwave+pittingedemaofthelowerextremities+++norashjointsnormalcase12yearsmale82Nofamilyhistoryofrenaldiseasew15kgUrinalysis:pro+++γ1.030PH5.5RBC-cast–Urineculture:-Hemogram:normalComplement:normalANA:-HepatitisBsurfaceantigen:-Albumin:25g/LBUN:normalCholesterol:8.9mmol/L24-hrurinetotalprotein:1.8gTuberculintest:-Nofamilyhistoryofrenaldis83questionsWhatisthediagnosis?MakedifferentialdiagnosisHowtotreatthepatient？questionsWhatisthediagnosis84case28yearsmaleEarlymorningfacialedema×5daysgeneralizededemawithascites×3dayscoffee-coloredurineoliguriaHadupperrespiratoryinfection2weeksagoCurrentimmunizationPhysicalexaminationuncomfortable-appearingBP105/70mmHgperiorbitaledema++breathsoundsdiminishedhearttonesnormalabdomendistendedfluidwave+pittingedemaofthelowerextremities+++norashjointsnormalcase28yearsmale85Nofamilyhistoryofrenaldiseasew30kgUrinalysis:pro+++γ1.030PH5.5RBC+++Urineculture:-Hemogram:Hb10g/LANA:-HepatitisBsurfaceantigen:-Albumin:20g/LBUN:normalCholesterol:8.5mmol/L24-hrurinetotalprotein:3.0gTuberculintest:-ASOCNofamilyhistoryofrenaldis86Thankyou!Thankyou!87NicetomeetyouNicetomeetyou88AcuteGlomerulonephritis

BeijingChildren’sHospitalaffiliatedtoCapitalUniversityofMedicalSciencesMengQunAcuteGlomerulonephritis

Beiji89AcuteGlomerulonephritisDefinitionEtiologyandPathogenesisPathologyClinicalfeaturesLaboratoryfindingsDiagnosisanddifferentialdiagnosisTreatmentAcuteGlomerulonephritisDefini90Definition

acuteonsetpostinfectiousglomerulonephritis:pharyngitisorpyodermaoftenbelongtoacutepoststreptococcalglomerulonephritis(APSGN)resultofinflammatoryglomerularinjuryDefinition

acuteonset91

Definitionhematuriaproteinuriaedemahypertensionrenalinsufficiency

Definitionhematuria92

commonage:5~14y<2y:raremale/female≈2/1self-limitedprognosis:finemorbidity:onthedecline

93

Etiologybacteria,viruses,mycoplasma…groupAβ-hemolyticstreptococcitype12:pharyngitistypes2,49,50,55,60:pyodermatype49:pharyngitisorpyoderma

Etiologybacteria,viruses,94Pathogenesis

secondarytoadirecttoxiceffectontheglomerulusofastreptococcalproteinthestreptococcalproductinduceanimmunecomplex-mediatedinjury

1)introducinganantigentotheglomrulus:plantedantigen2)depositionofcirculatingimmunecomplexes3)alteringanormalrenalantigentoaself-antigeninducinganautoimmuneresponsetotheself-antigen

Pathogenesissecondarytoadi95streptococcalantigenCICinsituICtriggerautoimmunitycomplementactivitedinflammatoryglomerularinjuryGBMdamagedhematuriaproteinuria

proliferativemesangialandendothelialcellsGFRoliguria,edema,hypertentionstreptococcalantigenCICinsit96Pathology

diffuseglobalhypercellularityproliferativemesangialandendothelialcellscrescentformationsubepithelialdepositioninterstitialedemainterstitialinfiltrationofleukocytePathology

diffuseglobalhyper97Clinicalfeatures

presentfromasymptomatictooliguricacuterenalfailurelatentperiod:afterpharyngitis:6~12daysafterskininfection:14~28daysClinicalfeatures

presentfrom98Nonspecificsymptomsandsigns

tirednessheadacheappetiteslightlyfevervomiting…

thesignofinfectionNonspecificsymptomsandsigns99Classicalmanifestation(1)

hematuria

grosshematuria:50~70%patientscoffee-coloredortea-coloredturntomicrohematuria:after1~2wClassicalmanifestation(1)

hem100Classicalmanifestation(2)edema:70%patientsreason:sodiumandfluidretentionpresents:faceperiorbitalupperextremitiesClassicalmanifestation(2)edem101腎炎腎病幻燈課件102Classicalmanifestation(3)hypertention:30~80%patientsmildtomoderate

schoolagepatients≥130/90mmHgpre-schoolagepatients≥120/80mmHgClassicalmanifestation(3)hype103Classicalmanifestation(4)proteinuria:theextentisvariousmost<3g/dnephrotic-rangeproteinuria:20%patientsurinevolume:Classicalmanifestation(4)prot104Severecase(1)

severehypervolemia:oftenoccurs<1weekoftheonsetofAGNcausedbysodiumandfluidretention

manifestations:dyspneacoughsevereedemaenlargedheartandliver…Severecase(1)

severehypervo105Severecase(2)hypertensiveencephalopathy:intheearlyonsetofAGNBP>150~160/100~110mmHgreason:CNSvasculitismanifestations:headachevomitingconfusionsomnolenceconvulsioncoma

Severecase(2)hypertensiveenc106Severecase(3)acuterenalfailure:last3~5d,<10dmesangialandendothelialcellsproliferationbloodvolumeofcapillaryglomerularfiltrationrate(GFR)Severecase(3)acuterenalfail107Non-Classicalmanifestation(1)

asymptomaticAGN:microhematuriawithoutotherclinicalmanifestation

contactingAGNpatientsorwhenstreptococciisepidemicNon-Classicalmanifestation(1108Non-Classicalmanifestation(2)extrarenalAGN:edemahypertentionC3

ASOurinetest:nomalorslightlyabnomalNon-Classicalmanifestation(2109Non-Classicalmanifestation(3)nephroticsyndromelikeAGN:severeedemahematuriaproteinuriahypoalbuminimiahypercolesteralimia

Non-Classicalmanifestation(3110Laboratoryfindings(1)urine:dysmorphicredbloodcellredbloodcellcastscastsofleukocytesrenaltubuleepithelialcellshyalineandgranularcastsproteinuriaLaboratoryfindings(1)urine:111erythrocytesedimentationrate:antistreptolysinO(ASO):pharyngitis10~14daysofphasereachthehightesttiterin3~5weeks,returntonomalin3~6monthantideoxyribonucleaseB(+):pyodermaLaboratoryfindings(2)erythrocytesedimentationrate112complement:returntonormal<8weekscirculationgimmunecomplexes:(+)BUN,Cr:correlatewithdiseaseactivityLaboratoryfindings(3)complement:Laboratoryfindin113Diagnosisacuteonset+abnomalurinetestoredema,oliguria,hypertentionAPSGN:above+streptococcalinfectialdisease+increasedASO+decreasedC3Diagnosisacuteonset+abnomal114Differentialdiagnosis(1)

AGNcausedbyotheretiologiesandpathogenicmechanisms:suchasvirusesDifferentialdiagnosis(1)115Differentialdiagnosis(2)IgAnephropathy

latent:24-48hnoedema,hypertentionC3:normalDifferentialdiagnosis(2)IgAn116Differentialdiagnosis(3)ChronicGNwithacuteepisode:

latent:short(1~2days)patients:malnutritionanemiagrowthretardedrenalfunction:usuallyabnormalproteinuria:severegravityofurine:Differentialdiagnosis(3)Chron117Differentialdiagnosis(4)Idiopathicnephroticsyndrome:

ASO:normalPathology

Differentialdiagnosis(4)Idiop118Differentialdiagnosis(5)rapidlyprogressiveglomerulonephritis(crescenticglomerulonephritis)

oliguriaoranuriarapidlossofrenalfuntionsecondaryGN:LupusnephritisPurpuranephritisHBV-associatedglomerulonephritis

Differentialdiagnosis(5)rapid119Treatment

nospecifictreatmentsupportivecare

Treatmentnospecifictreatmen120Generaltreatment

stayinbed:2~3weekssaltintake:60mg/Kg.dlimitproteinintake:0.5g/Kg.d(azotemiaperiod)Generaltreatmentstayinbed121Appropriateantibiotictherapy

penicillinG:10~14days

otherantibiotics:

accordingtosensitivitytestAppropriateantibiotictherapy122

Othertreatment

Edema:controlliquidandsaltdiureticsHypertention:rest,controlliquidandsaltNifedipineCaptoprilOthertreatment

Edema:cont123Treatmentofseverecases(1)

Severehypervolemia:restricttheintakeofliquidandsaltloopdiuretics:furosemidesodiumnitroprussidedialyticsupportTreatmentofseverecases(1)S124Hypertensiveencephalopathy:

sodiumnitroprusside

controlconvulsionAcuterenalfailure:

comprehensivetherapyTreatmentofseverecases(2)

Hypertensiveencephalopathy:T125Prognosisandprevention

recovery:95%severecasesmayprogressedtochronicGNandCRFprevention:preventinfectionPrognosisandprevention

recov126NephroticSyndrome

NephroticSyndrome

127Definition(NS)

massiveproteinuriahypoproteinemiaedemahyperlipidemiaDefinition(NS)

massiveprot128mayoccurasaresultofanyformofglomerulardiseasemaybeassociatedwithavarietyofextrarenalconditionsaccordingtoetiology:primaryNS:simpleandnephritictypeNSsecondaryNScongenitalNSmayoccurasaresultofanyf129usuallyaffectspre-schoolchildrenthemostcommonage:3~5yearsmale/female≈3.7/1mostcommonformofnephropathyusuallyaffectspre-schoolchi130racialandgenomicandenviromentalbackground:nephrin--NPHS1,podocin…steroidresponsiveNS:

associatewithHLA-DR7