glomerulonefriti

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prezentatsiya powerpoint glomerulonefriti n00 ostriy nefriticheskiy sindrom (glomerulonefrit) n01 bistroprogressiruyushiy nefriticheskiy sindrom (glomerulonefrit) n02 retsidiviruyushaya ustoychivaya gematuriya n03 xronicheskiy nefriticheskiy sindrom (glomerulonefrit) n04 nefroticheskiy sindrom (lipoidniy nefroz) n05 nefriticheskiy sindrom neutochnenniy (glomerulonefrit) n06 izolirovannaya proteinuriya s utochnennim morfologicheskim porajeniem (rubriki .0 - .8) n07 nasledstvennaya nefropatiya ne klassifitsirovannaya v drugix rubrikax (rubriki .0 - .8) n08 glomerulyarnie porajeniya pri boleznyax, klassifitsirovannix v drugix rubrikax (nefropatiya pri drugix boleznyax - rubriki n08.0 – n08.8) glomerulonefriti - gruppa morfologicheski raznorodnix immunovospalitelnix zabolevaniy s preimushestvennim porajeniem klubochkov, a takje s vovlecheniem kanaltsev i mejutochnoy (interstitsialnoy) tkani. glomerulonefriti mogut bit kak samostoyatelnimi nozologicheskimi formami, tak i odnim iz proyavleniy sistemnix zabolevaniy (skv, sistemnie vaskuliti, infektsionniy endokardit i dr.). etiologiya etiologicheskiy faktor udayotsya ustanovit: 80-90% sluchaev ostrogo glomerulonefrita 5-10% xronicheskogo glomerulonefrita. u ostalnix prichina ostayotsya neizvestnoy. k razvitiyu privodyat bakterialnie infektsii: streptokokkovaya (naibolee chyotkaya etiologicheskaya svyaz), stafilokokkovaya, tuberkulyoz, malyariya, sifilis i dr. v poslednee vremya …

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ak i insolyatsiya (pri volchanochnom glomerulonefrite). klassifikatsiya klassifikatsiya glomerulonefritov osnovivaetsya na videlenii: • vedushego sindroma (gematuricheskiy, gipertonicheskiy, nefroticheskiy); • varianta techeniya (ostriy, xronicheskiy i bistroprogressiruyushiy); • tipa morfologicheskix izmeneniy (proliferativnie i neproliferativnie formi). proliferativnie formi neproliferativnie formi ostriy poststreptokokkoviy (intrakapillyarniy) glomerulonefrit fokalno-segmentarniy glomeruloskleroz bistroprogressiruyushiy glomerulonefrit: s immunnimi depozitami; malo(pauci)immunniy* membranozniy glomerulonefrit mezangioproliferativniy glomerulonefrit glomerulonefrit s minimalnimi izmeneniyami iga-nefropatiya mezangiokapillyarniy glomerulonefrit ostriy poststreptokokkoviy glomerulonefrit ostriy poststreptokkokkoviy glomerulonefrit - diffuznoe immunokompleksnoe vospalenie pochechnix klubochkov, razvivayusheesya cherez 2-3 ned posle antigennogo vozdeystviya i klinicheski proyavlyayusheesya ostronefriticheskim sindromom. morfologicheski sootvetstvuet kartine proliferativnogo intrakapillyarnogo glomerulonefrita. zabolevanie razvivaetsya u lits molodogo vozrasta, v poslednee vremya vstrechaetsya v pojilom i starcheskom vozraste. v 2 raza chashe razvivaetsya u mujchin, chem u jenshin. etiologiya i patogenez razvitie svyazivayut s nefritogennimi shtammami β-gemoliticheskogo streptokokka gruppi a (shtammi 1, 2, 4, 12, 18, 25, 49, 55, 58 i 60). v ostruyu stadiyu zabolevaniya na bazalnoy membrane klubochkov i/ili v mezagialnoy …

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ayut sistemam komplementa, svyortivayushey, protivosvyortivayushey, kallikrein-kininovoy, a takje gistaminu i serotoninu. kaskad aktivatsii sistemi komplementa obespechivaet xemotaksis (c3a, c5a, c5-c7) i adgeziyu (c3b) polimorfnoyadernix leykotsitov i trombotsitov, degranulyatsiyu bazofilov i tuchnix kletok (c3a-c5a) i privodit k formirovaniyu membranoatakuyushego kompleksa c5b-c9. privlechyonnie v ochag provospalitelnie kletki videlyayut povrejdayushie lizosomalnie fermenti (proteazi) i aktivnie metaboliti kisloroda (respiratorniy vzriv), stimuliruyut ekspressiyu adgezivnix molekul, sintez aktivnix lipidov (faktora aktivatsii trombotsitov, eykozanoidov), tsitokinov (il, fno-α, trombotsitarnogo faktora rosta, transformiruyushego faktora rosta-β i dr.), provospalitelnix prostaglandinov, prokoagulyantnix i vazoaktivnix substantsiy, sposobstvuyushix stimulyatsii i proliferatsii endotelialnix, epitelialnix i mezangialnix kletok klubochka. vajnuyu rol igrayut takje kletochnie mexanizmi, gemokoagulyatsionnie (obrazovanie mikrotrombov v pochechnix sosudax) i gemodinamicheskie narusheniya. obshie i lokalnie gemodinamicheskie narusheniya pri ostronefriticheskoy stadii obuslovleni preimushestvenno vazokonstriktivnim effektom leykotrienov c4 i d4, angiotenzina ii, tromboksana a2. patomorfologiya intrakapillyarniy proliferativniy glomerulonefrit proxodit neskolko faz: ekssudativnuyu, ekssudativno-proliferativnuyu, proliferativnuyu ostatochnix yavleniy. klubochki uvelichivayutsya v razmerax, sosudistie petli polnostyu zanimayut polost …

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yarax obnarujivayut diffuznoe otlojenie igg i komponenta komplementa c3 granulyarnogo xaraktera. pri elektronnoy mikroskopii obnarujivayut otlojeniya elektronno-plotnogo materiala na epitelialnoy storone bazalnoy membrani klubochka - tak nazivaemie "gorbi" (humps). otmechayut takje izmeneniya otrostkov podotsitov, svyazannie s ix aktivnim vovlecheniem v protsess eliminatsii immunnix kompleksov. mezangialnaya proliferatsiya i sinexii mejdu kapillyarami i kapsuloy mogut soxranyatsya v techenie neskolkix mesyatsev posle vizdorovleniya. klinicheskaya kartina i diagnostika zabolevanie razvivaetsya ostro cherez 2-3 ned posle streptokokkovoy infektsii (angini, skarlatini ili streptopiodermii) i manifestiruet ostronefriticheskim sindromom - renalnie (oliguriyu, gematuriyu, proteinuriyu, tsilindruriyu) ekstrarenalnie (otyoki, ag i dr.) simptomi. • gematuriya - osnovnoy simptom, nablyudaemiy u 100% patsientov, prichyom v polovine sluchaev otmechayut makrogematuriyu (mocha priobretaet vid "myasnix pomoev"). proteinuriya chashe subnefroticheskogo urovnya, v chasti sluchaev (10-30%) mojet razvivatsya nefroticheskiy sindrom (proteinuriya bolee 3,5 g/sut, gipoalbuminemiya, gipoproteinemiya). • odnovremenno s gematuriey ili chut pozje razvivayutsya priznaki snijeniya filtratsionnoy sposobnosti pochek vplot do opn: umenshaetsya kolichestvo mochi …

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sa. narushenie krovoobrasheniya razvivaetsya po malomu krugu (interstitsialniy otyok lyogkix s pristupami serdechnoy astmi). vozmojni gidrotoraks i gidroperikard. v tipichnix sluchayax ostriy glomerulonefrit xarakterizuetsya tsiklicheskim techeniem s posledovatelnoy smenoy tryox periodov: ostronefriticheskogo, obratnogo razvitiya simptomov, kliniko-laboratornoy remissii. v poslednee vremya nablyudayut styortuyu (latentnuyu, atsiklicheskuyu) formu zabolevaniya, proyavlyayushuyusya mochevim sindromom (mikrogematuriya, proteinuriya menee 1 g/sut, tsilindruriya) i umerennoy nestoykoy ag. u 20-30% bolnix mojet ne bit ni ag, ni znachimogo snijeniya funktsiy pochek; po sushestvu ostronefriticheskiy sindrom u takix patsientov otsutstvuet. v bolshinstve sluchaev glomerulonefrit zakanchivaetsya polnim vizdorovleniem cherez 1,5-2 mes. techenie schitayut zatyajnim, esli otdelnie simptomi (izmeneniya v analizax mochi, ag ili nepolnoe vosstanovlenie funktsiy pochek) soxranyayutsya bolee 6 mes. prodoljitelnost simptomatiki bolee 1 goda obichno svidetelstvuet o perexode v xronicheskiy glomerulonefrit, chto nablyudayut v 5-10% sluchaev. neblagopriyatnie prognosticheskie faktori razvitiya xronicheskogo glomerulonefrita: • anuriya ili soxranenie oligurii bolee 3 ned; • razvitie nefroticheskogo sindroma; • persistiruyushaya ag; • snijenie …

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prezentatsiya powerpoint glomerulonefriti n00 ostriy nefriticheskiy sindrom (glomerulonefrit) n01 bistroprogressiruyushiy nefriticheskiy sindrom (glomerulonefrit) n02 retsidiviruyushaya ustoychivaya gematuriya n03 xronicheskiy nefriticheskiy sindrom (glomerulonefrit) n04 nefroticheskiy sindrom (lipoidniy nefroz) n05 nefriticheskiy sindrom neutochnenniy (glomerulonefrit) n06 izolirovannaya proteinuriya s utochnennim morfologicheskim porajeniem (rubriki .0 - .8) n07 nasledstvennaya nefropatiya ne klassifitsirovannaya v drugix rubrikax (rubriki .0 - .8) n08 glomerulyarnie porajeniya pri boleznyax, klassifitsirovannix v drugix rubrikax (nefropatiya pri drugix boleznyax - rubriki n08.0 – n08.8) glomerulonefriti - gruppa morfologicheski raznorodnix immunovospalitelnix zabolevaniy s preimushestve...

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