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Glomerulonefrita acuta postinfectioasa

Glomerulonefrita acuta postinfectioasa. =glomerulopatii ale copilului caracterizate prin aparitia, dupa o infectie acuta,a GN manifestata prin: - oligurie,hematurie,proteinurie - edeme,HTA,IRA ETIOLOGIE: streptococul B hemolitic gr A

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Glomerulonefrita acuta postinfectioasa

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  1. Glomerulonefrita acuta postinfectioasa =glomerulopatii ale copilului caracterizate prin aparitia, dupa o infectie acuta,a GN manifestata prin: - oligurie,hematurie,proteinurie - edeme,HTA,IRA ETIOLOGIE: streptococul B hemolitic gr A pneumococ,S.viridans,Stafilococ,meningococ virusi:adeno,echo,mixo,varicela,rujeola,urlian ricketsii,fungi,paraziti

  2. ETIOPATOGENIA GNAPS: tulpinile A12 si A49 poarta de intrare-respiratorie(faringoamigdalite) cutanata(piodermite)-exotoxine-Ag-CIC-depuneri pe versantul subepitelial al MB-fixare si activare complement*modif.perm.MB *activ.F12-microtromboze *oligurie,HTA CLINICA:B,3-13 a(5-10) infectie streptococica cu 2-3 sapt ant. per.latenta asimptomatica per.stare:4 sindroame

  3. Sindromul urinar:oligurie<300ml/m2 s.c/zi hematurie-macro(“zeama de carne”)/micro *ex.urina-proteinurie 0,5-2g/24 ore -cilindrurie- hematici!!,hialini,granulosi -densitate N sau > Sindromul de retentie azotata: >uree,creatinina,ac.uric Sindromul edematos:edeme renale-albe,moi, pufoase;fata,pleoape >G Sindromul hipertensiv:HTA mixta,moderata EPA HTIC(pseudoeclampsia uremica) !!FO-edem,staza

  4. *alte ex.lab:<CST si C3 >VSH,Fg,CRP <Na,>K(T inalt,ascutit pe EKG) prezenta CIC >ASLO>400uTodd TRATAMENT:*repaus la pat *restrictie Na, K, H20 (500 ml + diureza zilei precedente) * regim glucidic (gem,miere,zahar) lipidic (frisca,smintina,unt) restrictii proteice uree > 75mg/dl---prot.vegetale---prot.animale

  5. *eradicarea infectiei strept: Pen G,10zile *IRA, HTA: furosemid, diazoxid, hidralazina/nifedipin/captopril, enalapril dializa

  6. SINDROMUL NEFROTIC = sdr.clinico-biologic - edeme generalizate - proteinurie >0,1g/kg/zi masiva,lipidurie,oligurie - hipoproteinemie cu disproteinemie(<alb, gammaglob, >alfa2, betaglobulinele) CLASIFICARE: primitiv/secundar pur/impur (hematurie, HTA, retentie azotata)

  7. SINDROMUL NEFROTIC IDIOPATIC(PUR) B/F=2/1 9l-6a *debut: paloare, modif. comportament, inapetenta, g, v, diaree, oligurie, edeme *per de stare: edeme masive, ascita, hidrocel, hidrotorax oligurie<300 ml/zi manif. digestive (anorexie, diaree, d. abd) malnutritie, TA normala LABORATOR: proteinurie>0,1g/kg/zi selectiva (GM<100.000 albumina, siderofilina) lipidurie-corpi lipoizi <Na,>K urinar (hiperaldosteronism sec)

  8. *singe-hipoproteinemie<5,6g/dl -hipoalbuminemie<2,5g/dl <gammaglob,transferina >alfa2,betaglob modif.raport alb/globuline lipide totale,Col,TG>(ser lactescent) <Ca(fract legata de prot) >VSH uree,creat,aslo,CS-normale COMPLICATII:infectii-bacteriene(peritonita,cutanate,respiratorii,ITU), virale tromboze,malnutritie complic corticoterapiei

  9. TRATAMENT*repaus la pat *regim hiposodat,restrictie lipide,glucide(4-8g/kgc/zi),proteine(3g/kgc/zi) *prevenirea infectiilor,ingrijirea pielii *diuretice:furosemid1-2 mg/kg/zi *albumina umana *corticoterapia:2mg/kgc/zi(60mg/m2 sc/zi) 4 saptamini continuu----4 sapt discontinuu,actual s e scade progresiv doza inca 4 sapt

  10. SN-corticosensibil(90-95%) -corticorezistent -corticodependent*imunosupresoare-ciclofosfamida1-3 mg/kgc/zi azathioprina1-2 mg/kgc/zi clorambucil 0,2mg/kgc/zi

  11. INFECTIA TRACTULUI URINAR =inflamatie de natura infectioasa a tractului urinar si parenchimului renal *locul 3 in patol.inf. pediatrica ETIOLOGIE: gram negativi-E.Coli(90%!!) -Klebsiella,Enterobacter -Proteus,Piocianic +fungi(Candida),virusuri,protoz.(Trichomonas) *calea de patrundere-ascendenta(retrouretrala) -descendenta(hematogena) -contiguitate? *fact.fav:F,igiena<,raporturi sexuale,sarcina,RVU,litiaza,malformatiile(fimoza,VUP),DZ,constip.

  12. CLINICA:sdr.urinar(disurie,polakiurie,hematurie,enurezis,tenesme vezicale)+ sdr infectios(>> la copil<<)-febra,frison,tulb.digestive-anorexie,g,v,d.abd,modif.curbei ponderale,paloare,manif.sepsis,neurol. *nn !!B-simpt.digestive(inapetenta,v,meteorism) manif.neurol(hipotonie,conv,coma) tablou septicemic icter,CID *sugar(>incid la F)-anorexie,varsaturi,dureri abdominale,diaree, -febra(!sdr febril prelungit) -polakiurie,urini fetide,”pateaza scutecul” *copil>(F/B 10-30/1) simpt generale<< iar simpt.urinare>> PNC-HTA,nanism renal

  13. LABORATOR-urocultura +>100000 UFC/ml -<10000 UFC/ml Suspiciune 10000-100000UFC/ml 3 uroculturi + cu acelasi germene=dg *leucocituria >25 leuc/mm3 F >50 leuc/mm3 B *ITU inalta:>VSH,Fg,CRP+ureee,creatinina +ecografie,cistouretrografia mictionala,UIV,Rx.abd “pe gol”,scintigrafia renala

  14. TRATAMENT atac 7-10(14) zile cotrimoxazol(biseptol) 8-10mg/kgc ampicilina 100 mg/kgc nitrofurantoin 7 mg/kgc amoxicilina 50 mg/kgc augmentin 20-50 mg/kgc ampicilina+aminoglicozid(3-5-7mg/kgc) cefalosporina 3 ciprofloxacina 15-25 mg/kgc/zi +acidifierea urinii(vit.C) *urocultura la 48-72 ore

  15. intretinere chimioterapice ¼-1/3 din doza,seara biseptol 4 mg/kgc nitrofurantoin 3 mg/kgc acid nalidixic(negram) 20 mg/kgc monoterapie in cicluri de 10-14 zile *durata 3-6 saptamini /toata viata in PNC si malf.necorectabile chirurgical Trat.chirurgical(corectie malformatii,antireflux)

  16. INTOXICATIA CU ORGANO-FOSFORATE Mecanism-inhibarea colinesterazelor si acumularea acetilcolinei la nivelul sinapselor colinergice Compusi:paration,malation(toxice de lupta,actualmente insecticide) *fructe si legume nespalate

  17. CLINIC *sdr.muscarinic-wheezing,tuse,dispnee,EPA g,v,diaree,colici abd, lacrimare,hipersalivatie,hipersudoratie mioza,incontinenta urinara bradicardie *sdr.nicotinic fasciculatii,contractura,paralizii musculare HTA,tahicardie *sdr.nervos-central cefalee,conv.,coma

  18. LABORATOR-dozarea activitatii colinesterazei-intox.usoare(20-50%din N) medii(10-20%din N) grave(<10%din N)

  19. TRATAMENT-decontaminare cutanata(apa,sapun) instil. conjunctivale digestiva(carbune la <4-6 ore de la ingestie) -sustinerea functiilor vitale O2,IOT diuretice,cardiotonice diazepam terapie hidroelectrolitica si acido-bazica -atropina f 1ml=1mg doza 0,02mg/kg sc,im,iv se repeta pina la aparitia semnelor de atropinizare (midriaza, tahicardie, uscarea teg.si mucoaselor) -toxogonin 4-8mg/kgc iv,sc se repeta la 4-8 ore

  20. INTOXICATIA CU SUBSTANTE COROZIVE =ingestia accidentala/scop suicid a substantelor corozive(acizi sau baze tari) Acizii - necroza de coagulare Bazele - necroza de lichefiere *leziuni ulcero-necrotice bucale,esofagiene - bazele, gastrice – acizii perforatii,stenoze

  21. Substante-soda caustica,lesia de sapun,apa de var zone:Moldova,Turnu-Severin,Teleorman 2-4 ani CLINIC-dureri,arsuri,sialoree,disfagie,varsaturi sanguinolente----soc,edem glotic,perforatii EVOLUTIE acut 2-4 sapt,ameliorare clinica aparenta dar dezv.stenoze esofagiene+anemie,malnutritie TRATAMENT:in perioada acuta Atb+corticoterapie Ulterior-dilatatii esofagiene cu bujii flexibile,pe cale endoscopica -gastrostomie(paleativ) -esofagoplastie cu tub gastric

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