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1、Chronic GlomerulonephritisLi ManliWhat 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-stagerenal disease

2、(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 150mgEtiology and PathogenesisunclearA small number due to acute post-streptococc

3、al glomerulonephritis.Etiology and PathogenesisPathogenesisimmune factorsimmune factorsinflammation mediated byinflammation mediated by primary immunological primary immunological reactionreaction MAIN non-immune factorsnon-immune factorspphypertensionhypertensionppsevere proteinuriasevere proteinur

4、iapp hyperlipidemia(high blood fat)pphyperuricemia(high uric acid)(etc)hyperuricemia(high uric acid)(etc)during disease processduring disease process.pathologymesangial proliferative nephritismesangiocapillary glomerulonephritismembranous nephropathyfocal segmental glomerulosclerosis(FSGS)sclerosing

5、 glomerulonephritisClinical manefestation edema:hypertentionhypertention female at the age of 31impaired visionophthalmologist fundus hemorragehypertention(160/102mmHg)cardiologisturine analysis kidney fuctionhypertentionhypertentionhypertentionClinical manefestationedema;hypertention;gross hematuri

6、a;non-specific symptom：pain in the lumbar、fatiguechronic renal failureabnormal urine analysis without symptomLaboratory 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 biop

7、sy：to make pathologic diagnosis,help therapy,and prognosticatediagnosis abnormal urine analysis(proteinuria and,or hematuria),edema,hypertention with or without renal disfunction,excluding secondary and hereditary glomerulonephritis.Differential diagnosis1.Lupus nephritisseconary to Systemic Lupus E

8、rythematosus(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 SLESkin and joints:fever,baldness,oral ulcer,light sensitiveness,rash(erythema),joint p

9、ainManefestaion of SLECardiovasular system(pericarditis,myocarditis)Polyserositis(hydrothorax,ascites,Pericardial effusion)Manefestaion of SLELung:hydrothorax,interstitial peumonia,pulmonary arterial hypertentionNervous system:seizure,headache,confusionPsychiatric system:Hematologic system:anemia,le

10、ukopenia,thrombocytopeniaDigestive system:Kidney:lupus nephritisIC widely deposit in Glomerular.IgG、IgA、IgM are positive.Case report female,23yserythema,mild jont painPE:mild to moderate fever,erythemaLab tests:urine analysis:mild proteinuriablood routine:anemia,leukopeniadsDNA antibody:positiveCase

11、 reportFemale,33ysedema,dypneaPE:edema,HR:105beat/minLab tests:urine analysis:proteinuria and hematuriablood routine:anemiadsDNA antibody,anti-Sm antibody:positivecardic ultrasound:pericardial effusionChest X-ray:hydrothoraxA long history of diabetes,then urinary abnormality.Evidence of other diabet

12、ic 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

13、 thanglomerular injury;mild proteinuria;complicated with heart and brain injury3.Benign arteriolar nephrosclerosiscaused by allergic purpurahigh incidence in children.symmetrical purpura(the four limbs)hematuria,different levels of proteinuriajoint painabdominal pain and bloody stool4.Purpura nephri

14、tisRecurrent 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(10 years old);Kidney damage(hematuria,mild-to-moderate prot

15、einuria and progressive renal impairment),deafness,eyes impaired7.other nephritisAsymptomatic hematuria or/and proteinuriaAcute post-infection nephritis:A precursor infection then acute onset C3 dynamic changeself-healing tendency treatmentDiet therapyBlood pressure controlSymptomatic treatmentDiet

16、therapyWater intake restriction when edemaLow salt diet when hypertentionLow protein diet when renal insufficentBlood pressure controlSystemic hypertension and high pressure in glomeruli are important risk factors accelerating the progress of kidney disease Drugs:ACEI(angiotensin converting enzyme i

17、nhibitor)ARB(angiotensin receptor blocker)reduce the renal capillary pressure decrease proteinuria protect renal fuctionOther antihypertensive drugs:diureticscalcium channel blockersbeta receptor blockers alpha receptor blockersTarget blood pressure:130/80 mmHg(proteinuria 1 g/d)Symptomatic treatmen

18、tcontrol infectioneliminate edemadecrease proteinuria:glucocorticoid and immunosuppressive agentAvoid aggravating factors:keep away from infection,renal toxic medicine(some Chinese medicine,antibiotics,contrast agent,NSAID)prognosisProgress slowly and continuously,whichwill eventually result in chronic renal failure.velocity of the progression depends on:Pathological typeThe degree of proteinuriaBlood pressure controlOther various risk factors(infection,medication,diet,etc.)Thanks for your attention