泌尿系統(tǒng)疾病課件2

1、泌尿系統(tǒng)疾病課件2泌尿系統(tǒng)疾病課件2Kidney 腎臟 Ureter 輸尿管Bladder 膀胱 Urethra 尿道Kidney 腎臟 Ureter 輸尿管ContentsLaboratory and image Evaluation of Urinary SystemUrinary Tract Infection (Vesicoureteric Reflux 膀胱輸尿管反流)Acute NephritisNephrotic SyndromeContentsLaboratory and image EEvaluation of Urinary SystemLaboratory Evaluat

2、ion of Renal FunctionUrinalysis Serum Analysis (BUN, Cr, Albumin, pH, K+ Na+ Cl-)Urine CultureEvaluation of Urinary SystemLThree urine samples are shown. The one at the left shows a red, cloudy appearance. The one in the center is red but clear. The one on the right is yellow, but cloudy.white blood

3、 cell castred blood cell castoxalate crystalsThree urine samples are shown.Evaluation of Urinary SystemLaboratory Evaluation of Renal FunctionMeasurement of Glomerular Filtration Rate, GFR (Ccr, eGFR) Urine Concentrating Ability 尿濃縮功能1,25(OH)2 Vitman DEPO （促紅細(xì)胞生成素）Laboratory Evaluation of Immunologi

4、c Function ( complement, IgG, anti-GBM antibody)Evaluation of Urinary SystemLImage EvaluationRenal ultrasonographyVoiding cystourethrography （排尿性膀胱輸尿管造影）Radioisotope studies （核素顯像）Renal arteriography or venography （腎動(dòng)脈/靜脈造影）MRU/CTUCongenital Anomalies of the Kidney and Urinary TractCAKUT Image Evalu

5、ationRenal ultrasonRenal Biopsy and PathologyMCD, FSGS, MN, MPGN, MsPGN, IgAN, LN, HSPNRenal Biopsy MCD, FSGS, MN, 泌尿系統(tǒng)疾病課件2CKD（Chronic Kidney disease）- 復(fù)旦大學(xué)附屬兒科醫(yī)院 孫利，徐虹等 臨床兒科雜志 2003劉海梅，徐虹等 實(shí)用兒科雜志 2004兒科醫(yī)院病因分析1990年1月至2003年3月CKD（Chronic Kidney disease）-ESRD in ChildrenGlomerulonephritis 31%先天腎尿路畸形 (C

6、AKUT) 42% (Singapore 2005)ESRD in ChildrenGlomerulonephUrinary Tract InfectionUTI ( CAKUT )Urinary Tract InfectionCommon in children 3-5% girls 1-2% boysVary with agePredominantly in boys up to age 3 months Equally in boys and girls from 3-12 monthsIncreasingly in girls rather than boys after age 1

7、yearUrinary Tract InfectionCommon in children Urinary TraMost infections are caused by Escherichia coli ( E. coli 大腸桿菌, 75-90% )Other bacteria ：Klebsiella species （克雷伯桿菌 ）Proteus species（變型桿菌 ）Enterococcus species（腸球菌 ）S. saprophyticus（腐生菌 ）Urinary Tract InfectionE. coliMost infections are caused by

8、 The most common host factor predisposing to UTI: Urinary StasisVesicoureteric Reflux, VURObstructive uropathy（尿路梗阻）Neuropathic bladder （神經(jīng)原性膀胱）ImmunityNephrotic SyndromeUrinary Tract InfectionThe most common host factor prClinical featuresIn neonates and very young infantile jaundice may occur and

9、septicemia may developIn infants, UTI may occur with or without fever and symptoms are non-specific: vomiting, diarrhea, irritability, failure to thriveBetween 1 and 5 years of age, fever, malaise, abdominal discomfort, urinary frequency, and nocturnal enuresis are the presenting features UTI must b

10、e suspected in any febrile infant with no obvious clinical sourceVeryImportant!Clinical featuresUTI must be s UTIrecurrent UTI VUR Renal Scar (腎瘢痕) Hypertension/Reflux Neohropathy ESRD Very Important! UTUrine sampleUrinary analysis WBC 5 /HPPositive nitrite stick testUrine sample should be cultured

11、before use of antibioticConfirmation of Diagnosis: a pure growth of a single pathogen 105/mlProteus speciesUrine sampleUrinary analysis Further investigationafter a first confirmed UTI ：all children require further investigation to identify: anatomical or functional abnormalities (such as VUR ) rena

12、l scars/ renal functionFurther investigationafter a fPrimary VUR1% in ChildrenI-V gradesPrimary VUR1% in ChildrenTreatmentAntibiotics is indicated as soon as a urine sample has been taken for cultureTreatment should be modified when urine culture results are available TreatmentAntibiotics is indicaT

13、reatmentParenteral antibiotics should be given to infants any systemically unwell older child children with a sign of acute pyelonephritisor known urinary tract abnormality TreatmentProphylactic antibiotics (預(yù)防性應(yīng)用抗生素)after treatment of the acute infectionshould be given in low doseuntil investigation of the urinary tract is completeprophylactic antibiotics are given at least until the child is 2-3 years old, if VUR or renal scar was showedGuildlinesInternational new conceptControversialMattoo TK. Vesicoureteral reflux and reflux nephropathy. Adv Chronic Kidney Dis.