血尿蛋白尿鑒別定稿(精品)-文庫吧資料
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【正文】 十九頁，共七十九頁。,第四十七頁，共七十九頁。)方法 常見的病理類型 常見的病理改變,第四十五頁，共七十九頁。,病理(b236。,病因(b236。n b236。n b236。,進(jìn)一步檢查(jiǎnch225。,3 Physical Examination,1. Vitals hypertension, fever 2. O/E edema, skin paleness or jaundice, rashes external genitalia〔外生殖器〕 joints for signs of arthritisred, warm, or swollen abdomen: masses or tenderness. CVA tenderness enlarged kidneys. length and weight and plot on growth chart.,第四十一頁，共七十九頁。,2. Family History,helps to differentiate hereditary from nonhereditary : 1. Proteinuria family members must have had previous urinalysis to ascertain this 2. Renal Disease Polycystic Kidney Disease Nephrotic Syndrome, Fanconi Disease renal dialysis kidney transplantation 3. Others：hearing/ocular impairment (Alport Syndrome),第三十九頁，共七十九頁。n y225。nɡ shǐ),功能性 病理性 腎小球性 腎小管、間質(zhì)性 溢出(y236。,1. History of Presenting Illness,at the end of the history, one should be able to discern: 1. benign vs pathologic proteinuria (if pathologic then) 2. glomerular vs tubulointerstitial proteinuria (if glomerular then) 3. hereditary vs nonhereditary (if nonhereditary then) 4. acute GN vs chronic GN (if chronic then) 5. primary GN vs secondary GN 6. nephrotic vs nonnephrotic proteinuria 7. proteinuria with or without hematuriauria,第三十七頁，共七十九頁。,quality associated with hematuria severity ： pathologic if associated with hematuria or Nephrotic Syndrome likely to be a primary GN unlikely to be benign etiology or secondary GN timing acute vs acuteonchronic intermittent vs persistent duration of proteinuria,第三十五頁，共七十九頁。nɡ shǐ)血尿,第三十三頁，共七十九頁。n su237。,排除假性血尿 血凝塊 血尿中混血凝塊常提示非腎小球疾患出血 血尿與全身疾病及呼吸道感染的時間關(guān)系 PSGN：感染后10－14天出現(xiàn)血尿 IgAN： 幾乎同時發(fā)生，一般不超過3天。n)方法及程序,病史 體格檢查 實驗室檢查 特殊(t232。o)、蛋白尿臨床診斷 2.腎功能 3.病因:繼發(fā)腎病?原發(fā)腎病 4.病理 5.并發(fā)癥,第三十一頁，共七十九頁。n)層次,1.血尿(xu232。o)的診斷與鑒別 蛋白尿的診斷與鑒別 血尿、蛋白尿的診斷與鑒別診斷,第三十頁，共七十九頁。,內(nèi) 容,血尿(xu232。ngli224。,診斷(zhěndu224。i)和特點,腎小球性蛋白尿 腎小球濾過屏障損害 〉2.0 g/24 h 大、中、小分子 腎小管性蛋白尿 腎小管對正常濾過蛋白的重吸收障礙 2.0g/24 h，小分子 溢出性蛋白尿 血漿中某種蛋白質(zhì)濃度過高，經(jīng)正?；虍惓ＤI小球濾出 分泌(fēnm
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