1PhysiologicalfeaturesGlomerularfiltrationrate(GFR):

lowinneonateandinfantperiodUrineconcentrationanddilutionability

shortageRenaltubulefunction

insufficiency2PhysiologicalFeaturesNormalurinaryoutput:

neonate:48h1～3ml/kg.h3～10d100～300ml/d2m250～400ml/d

～1y:400～500ml/d

～3y:500～600ml/d

～5y:600～700ml/d

～8y:600～1000ml/d

～14y:800～1400ml/d

＞14y:1000～1600ml/d3Physiologicalfeaturesurinaryoutput

neonateml/kg.hInfanttoddlerml/dPreschoolageml/dSchoolageml/doliguria＜1.0＜200＜300＜400urineless＜0.5＜504UrinalysisColor:colorlessorlightyellowpH:5～7Specificgravity:1.003～1.030(often1.011～1.025)Osmoticpressure:

infant:50～600mmol/L

children:

500～800mmol/LPhysiologicalfeatures5Urinalysisprotein：

negative：≤100mg/m2.24hprotein／creatinine≤０.２

positive：＞150mg/d

or＞4mg/m2.h

or＞100mg/LUrinarycellandcast：

Urinarysediment:RBC＜3/HP

WBC＜5/HP

colorlesscastoccasionally

12hurineAddiscount：RBC＜500000WBC＜1000000cast＜5000

PhysiologicalFeatures6SerumanalysisThestandardindicatorsofrenalfunction

ureanitrogenandcreatinine

Theratio

:10:1.

Theratioincrease:

renalperfusion

or

urineflowisdecreased7Section2Classificationof

GlomerularDisease8ClinicalClassification一、PrimaryGlomerularDisease

Glomerulonephritis

acutglomerulonephritis(AGN)

(Acutepoststreptococcalglomerulonephritis,APSGN)rapidlyprograssive(RPGN)

persistentchronic9ClinicalClassificationniphroticsyndrome,NS

simpleTypeNSnephriticTypeNS

steroid-responsiveNSsteroid-resistantNSsteroid-dependentNSrelapsandfrequentlyrelaps10ClinicalClassificationIsolatedhemarutiaorproteinuria

Isolatedhematuria

persistentrecurrent

IsolatedProteinuria

orthostaticnon-orthostatic

11ClassificationClassification二、SecondaryglomerulardiseasespurpuranephritislupusnephritisHBV-associatedglomerulonephritisothers:poison,drug,viruset.al三、Hereditaryglomerulardiseasescongenitalnephroticsyndromehereditaryprogressivenephritisfamilialrecurrenthematuria12Section3AcuteglomerulonephritisAG急性腎小球腎炎AcutepoststreptococcalglomerulonephritisAPSGN急性腎小球腎炎13EtiologygroupAβ-heamolyticstreptococcalinfection.

upperrespiratorytractinfection51%skininfection25.8%acutepharyngtis，scarletfever1～5%othersbacteriaVirushelminth14Nephritisstrainassociatedprotein(Ag)antigen-antibodycomplexesactivatethecomplementsystem

inciteglomemlarinflammationCap.endotheliumGMBGFR↓oliguriaNa,water↑edemahypertensionProteinuriahematuriacastMechanism15Clinicalmanifestation

respiratorytractinfection

6~12dayspreviously

skininfection

14~28

dayspreviouslyrecenthistoryofgroupAβ-heamolyticstreptococcalinfection.16Clinicalmanifestation

1.edema

70%，eyelidandface，

non-pitting；oliguria2.hematuria

50～70%,grosshematuriacoffee-colored

ortea-coloredurine

Typicform17Clinicalmanifestation3.hypertension

30～80%,headachemaybepresent

4.Proteinuriadegreeisdifferent

pathology:

membranoproliferationTypicform18ClinicalmanifestationSeverehyperaemiaonthe

circulatorysystemHypertensiveencephalopathyAcuterenalfailure

severe

form19ClinicalmanifestationAtypicformAsymptomsAGNOutofrenalsymptomsAGNAGNwhichissimilartonephroticsyndrom20

hematuria：

+~+++

ESR：

↑↑

ASO：

10-14d

3-5w

peak

3-6m

normal

C3：

↓↓

6-8wnormal

protein:

+~+++Laboratoryevaluation

21Diagnoses

previouslystreptococcaldisease

acuteonset

edema,

hematuria,

Proteinuria,

cast,

hypertension

ASO，C322TreatmentRest:

keepthebed2～3W

Non-symptom:

Beoffthebed

ESRnormal:

gotoschool

Urinarysedimentcount:

normal,resumemovementGenerallytreatmentrest

23diet

Edemaandhypertension:Waterandsodiumsalt:belimited

sodiumsalt:

60mg/(kg.d)

water:

potentiallylosswatervolume

＋urineoutput

serumlevelsofureanitrogenandcreatinine:proteinislimited

TreatmentGenerallytreatment24

Treatment

penicillineForinfectionifstillpresentPenicillin10～14dAntibiotictherapy

25TreatmentdiureticsantihypertensiveDihydrochlorothiazideFurosemideNifedipineCaptoprilReserpineSymptomatictreatment26TreatmentSeverehyperaemia

HypertensiveencephalopathyAcuterenalfailurediuretics、antihypertensive、hemodialysisorperitonealdialysis

SodiumNitroprusside:thefirstchoices,SymptomatictreatmentSymptomatictreatmentaccordingtovariousmanifestation27Prognosis

and

prevent

Theacuteabnormalitiesgenerallyresolvein2-3weeks;keypointofprevention:preventandcureinfection28Section4NephroticsyndromeNS

腎病綜合征29Introdution

Itisglomerulardisease,whichhascharacteristicclinicalandlaboratoryfindings,causebyvariousfactors.

Age:schoolage

male:female：3.7:1

30Characteristic

proteinuriahypoproteinemia

（hypoalbuminemia）

hyperlipemiaandhyperlipoproteinemiaedema31Classification1.primarynephroticsyndrome,PNS2.secondarynephroticsyndrome,SNS3.congenital

nephroticsyndrome,HNS32Pathophysiology

Primaryrenalinjury

proteinuria

hypoproteinemiaedemahyperlipidemia

secondaryPathophysiologicalchange33Glomemlarcapillaryvasselmoleculeandstaticbarrier－分子屏障靜電屏障分子屏障plasmproteinmoleculewithvariousdiameter

－－－－－－－－－－－－－－－－－－34ClinicalFinding

anddiagnosisAccordingtoClinicalFinding

1.simpletypeNS2.nephritictypeNS35Clinicalmanifestation

anddiagnosis1.simpletypeNS

1)proteinuria:

urineprotein3＋～4＋

24hurineproteinquantitate≥50mg/kg

2)hypoproteinemia：

plasmalbumin＜25g/L

3)hyperlipidemia：

plasmcholesterol

＞5.7mmol/L

4)edema：

theseriouscase:anasarca，ascites,pleuraleffusions36ClinicalFinding

anddiagnosis2.nephritictypeNS

Thereisoneormoreofitemsunderline:

①hematuria：

Urinarysediment:

3timeswithin2WRBC≥10/HP

②hypertension：

schoolage≥130/90mmHg,preschoolage≥120/80mmHg。

③renalfailure

④persistenthypocomplementemia

37Complication1.infection

respiratorytractskinurethraperitonitis38Complication2.electrolytedisorderandintravascularvolumedepletion3.thrombosisandhypercoagulability

renalveinthrombusiscommon39Complication

4.acuterenalfailure5.growthanddevelopisretarded40TreatmentGenerally

1.rest2.diet:Waterandsodiumsaltarelimitedprotein：1.5~2g/kg·dCalciumandVitD；

3.diuretics:DihydrochlorothiazideFurosemide4.preventionandcureinfection41TreatmentCorticosteroidtreatment

：

Assoonasthediagnosisismade,corticosteroidtreatmentshouldbestarted.

Predinisone:2mg/kg.d(maximum,80mg/d),6W1.5mg/kg，singledose,qod,p