24. Characteristics of Glomerular Diseases Parameter Glomerular Tubulointerstitial Proteinuria MW of Protein Renal morphology RBC Morphology Massive>++ >1.5~2.0g/d Large/Medium/Small Symmetry dysmorphic Small amount<2+ <1.0g/d Small Asymmetry normal
25. Hematuria Isomorphic nonglomerular erythrocytes. The arrows indicate the so-called crenated erythrocytes 皱缩红细胞 , which are a frequent finding in nonglomerular hematuria. Dysmorphic glomerular erythrocytes . The dysmorphism consists mainly in irregularities of the cell membrane. Inset , Acanthocytes 棘红细胞 with their typical ring-formed cell bodies with one or more blebs 水泡 of different sizes and shapes. Examination of the urine sediment by a phase constrast microscope Dysmorphic glomerular erythrocytes>8000/ml,Acanthocytes>5%
29. How are glomurular diseases diagnosed ? Usually by history, physical findings, Urinalysis and other laboratory data. Occasionally a renal biopsy must be performed !
58. Introduction Incidence: Etiology: Clinical Features: Clinical Course: Loss of net negative charge on capillary basement membrane. Nephrotic syndrome. Prominent proteinuria & edema No hypertension Sensitive to steroid, relapse may occur. 80% of nephrotic syndrome in children Minimal Change Disease
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60. Why is a thorough Clinical evaluation important in patients with the nephrotic syndrome ! Many such patients have an occult malignancy !
65. CASE III EM: subepithelial electron dense material
66. It’s Clearly a case Of carcinoma related Membranous nephropathy !
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68. Introduction Membranous Nephropathy Incidence: Etiology: Path: Clinical Course: Immune complex disease. May associated with carcinomas, infections, drugs, and heavy metals. Some adults develop ESRD. Diffuse, uniform basement membrane thickening with subepithelial projections (“spikes”). Commonly occurred in middle&old-aged people
73. How to use glucosteroids(1) 0.25mg/kg.d Slow the speed of tapering 1mg/kg.d×8w 0.5mg/kg.d Taper 5mg per 1-2week Maintenance for 1 year
74. How to use glucosteroids(1) 0.25mg/kg.d Slow the speed of tapering 1mg/kg.d×8w 0.5mg/kg.d Taper 5mg per week Maintenance for 1 year Sufficient initial dose
75. How to use glucosteroids(3) 0.25mg/kg.d Slow the speed of tapering 1mg/kg.d×8w 0.5mg/kg.d Taper 5mg per week Maintenance for 1 year Sufficient initial dose Slow tapering
76. How to use glucosteroids 0.25mg/kg.d Slow the speed of tapering 1mg/kg.d×8w 0.5mg/kg.d Taper 5mg per week Maintenance for 1 year Sufficient initial dose Slow tapering Long maintenance
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79. 急性肾小球肾炎 Acute GN Endocapillary proliferation:A diffuse proliferative and exudative glomerulonephritis :infiltration of the glomerular tuft by neutrophils and monocyte