西安交通大学医学院泌尿系统疾病课件 Chronic Glomerulonephritis (CGN).pptVIP

 Chronic Glomerulonephritis(CGN) Nephrology department Chronic glomerulonephritis(CGN): It is a group of renal glomerular diseases with the clinical manifestations of hematuria, proteinuria, edema and hypertension. The feature of CGN : Chronic at onset Clinical behavior:Long asymptomatic abnormal uria, slowly progressive Etiology The cause of CGN are not clear. It can be resulted from many causes and different pathologic of primary renal diseases , such as MPGN, MN, RPGN , FSGN and fewer AGN.At the end stage ,developing to sclerosing GN. Pathogenesis（I） Immune mechanism Inflammatory mechanism Non-immune,non-inflammatory factor play roles in CGN: The chronic procedure is relatived to hypertension, proteinuria, hyperlipidemia etc. Pathogenesis（II） Reduction in renal mass leads to hypertrophy of the remaining nephrons with hyperfiltration, and the glomerular filtration rate in these nephrons transiently returns to normal levels.These adaptations place a burden in the remaining nephrons and lead to progressive glomerular sclerosis and interstitial fibrosis, suggesting that hyperfiltration may worsen renal function. Pathology In early stage of CGN, the kidneys are in normal size or slightly small. As disease developing, the kidneys become smaller an smaller. In the end stage, the cortex is thin, glomeruli are of a cellular sclerosis and tubular atrophy, interstitial fibrosis and cellular infiltration are widespread. Clinical Manifestations(I) It is more common in men and frequent in young or middle aged people. Proteinuria: It is often of middle degree(1~3g/d), but heavy proteinuria may happen in some cases. Hematuria: It may be microscopic or gross hematuria, but must be glomeruli in origin. Clinical Manifestations(II) Edema: periorbital edema is noted on awakening, and/or pitting edema of the lower extremities. Hypertension: About 50% patients have HP, and about 80% patients have HP at the stage of