慢性腎小球腎炎英文教學(xué)課件

1、Chronic GlomerulonephritisDefinitionChronic glomerulonephritis is the advanced stage of a group of kidney disorders, resulting in inflammation and slowly worsening destruction of internal kidney structures called glomeruli. clinical feature: persisting proteinuria、hemoturia、 hypertension 、edema、chro

2、nic renal failure, insidious onset or as a late sequel of acute glomerulonephritis;the kidneys are symmetrically contracted and granular, with scarring and loss of glomeruli and the presence of tubular atrophy and interstitial fibrosis. Etiology and Pathogenesisvaried cause、varied pathology of idiop

3、athic or primary nephritisa few come from AGNHypertension 、proteinuria、hyperlipemia can make CGN progressmay develop after survival of the acute phase of rapidly progressive glomerulonephritis. In about one-quarter of patients with chronic glomerulonephritis, there is no prior history of kidney dise

4、ase, and the disorder first appears as chronic kidney failure.Immune inflammation: major Humoral immunity in situ immune complexe （IC） circulating immune complexe （CIC） Cellular immunity circulating Immune complex depositin situ immune complexe depositPathology Minimal Change Disease (10-15%) Membra

5、nous Glomerulonephritis (25-30%) Focal Segmental Glomerulosclerosis (20-25%) IgA Nephropathy (5-10%) Membranoproliferative Glomerulonephritis (5%)Minimal chang PAS x 410FSGS PAS x 410FSGS PASx260MN。 PAS x 320 MN PASM x 1000 PAS x 260 PAS x 260PASx260 PAS x 100Clinical featureslowing and delitescence

6、proteinuria, hematuria,hypertension,edemaimpairment of renal function acute episode at the end , developed to CRFanergy,fatigue,waist soreness,loss of appetite,edema,et.alBecause symptoms develop gradually, the disorder may be discovered when there is an abnormal urinalysis during a routine physical

7、 or during an examination for another, unrelated disorder. It may be discovered as a cause of high blood pressure that is difficult to control.laboratory examinationurine abnomal:proteinuria,BLD,casts,et.alrenal function insufficiency:increase of BUN,Scr，decrease of Ccr，ripid aggravated for infectio

8、n,tired,blood pressure increase,or nephrotoxicity drugs anemiaTests that may be done include: Chest x-ray Kidney or abdominal CT scan Kidney or abdominal ultrasound IVP Urinalysis A kidney biopsy may show one of the forms of chronic glomerulonephritis or scarring of the glomeruli.Diagnosis abnormal

9、of urine analysis,edema,hypertension,for more than 1 year。except Secondary Nephritis and Hereditary Nephritis。less than 1 year with :acute nephritis sydrome.only midrange proteinuria and light to midrange edema.which need biopsyDifferential diagnosis1.Latent glomerulonephritis：asymptomatic hematuria

10、 and/or proteinuria without edema、hypertension and renal function insufficiency。with lightly pathologic changes。 2. Acute glomerulonephritis 3.Hypertension associated nephropathy 4. Secondary Nephritis（SLE） 5. Hereditary Nephritis:Alport syndrome Treatment Dietary therapy Restriction protein and pho

11、sphorus intakeDietary restrictions on salt, fluids, protein, and other substances may be recommended to help control of high blood pressure or kidney failure. High protein consumption glomerular hyperfiltration, intraglomerular pressure accelerate the progression of nephropathy Restriction protein i

12、ntake blunt urinary albumin excretiondecline GFRDietary therapyDietary therapyDietary Protein RestrictionReduce protein intake to 1g/d, target BP is 125/75mmHg.If proteinuria 1g/d, target BP is 130/80mmHg.Correction of Anemia use EPO, add Ferrum and folate acidAnemia enhances renal hypoxia, which st

13、imulates release of profibrotic cytokinesErythropoietin therapy and correction of anemia may slow CKD progressionTarget Hb 12 g/dLTreatment of Dyslipidemiaslow fat diet,exercise, medicineDyslipidemia is common in CKD (VLDL; LDL; HDL)Evidence that dyslipdemias may initiate CKD and accelerate progress

14、ion of CKDMechanism unclearStatins CKD progressionStatins also risk of atherosclerotic CVD, which is main cause of mortality in CKD patientsTarget LDL 100 mg/dLTight glycemic control in diabetics (HbA1c 6.5%)Dietary salt restriction ( 5 g/d)Weight control (BMI 25)Antiplatelet therapyAvoid nephrotoxic drugschinese herbs(rhubarb)Other StrategiesCorticosteroids and immunosuppressives according to pathologic type,proteinuria,renal functionPrognosisThe outcome varies depending on the cause. Some types of glomerulonephritis may get better on their own.At the end,CGN will progress to uremiaThere