1、Acute Glomerulonephritis,Pediatric dept of TCM hospital of Guangdong Province,Content,Familiar with Epidemiology Familiar with Diagnosis Master Differentiation of syndrome and treatment,Description of ancient doctor of TCM,灵枢肿胀篇: Shuizhong in TCM (edema) start from eyelid,mild eyelid edema as if one
2、 just get up,rapid pulse in neck, intermittent cough,cold feeling between perineum and thigh, edema in anterior tibial site and feet,enlarged abdomen,nopitting as if water in it.,Description of western medicine,Edema,Hypertension,hematuria,Definition of AGN,Acute onset A disorder of a group of glome
3、ruli due to different causes Clinical manifestation: hematuria,edema,proteinuria,hypertension,Epidemiology of AGN,Morbidity is highest in renal and urogenital disorder,Epidemiology of AGN,Acute on set Prevail in children in 3-12,especialy in school age population,seldom seen in children below 2. Mor
4、bidity ratio of M:F is 1.52.5:1,Pathogenesis of AGN in western medicine,Group A -hemolytic streptococci,Etiology,AGN,Pathogenesis,Group A -hemolytic streptococci （Ag）,circulation immune complexes,leukocytes (release),Damage GBM,GFR,Retenion of water and Natrium,oliguria,Blood Volume overload,Edema,H
5、ypertension,hematuria proteinuria,complement system(C3),Inflammation of kidney,blood coagulation system (thrombus),Cell Proliferation,Etiology and Pathogenesis of AGN in western medicine,Medical history：upper respiratory tract infection：12weeks before，winter and spring；skin infection ：23 weeks befor
6、e,summer and autum,Pathogenesis,Inflammation of kidney due to circulation immune complexes,Pathology of AGN,Pathology,AGN,PATHOLOGY,PASM-HE染色 400 正常,PASM染色 100 ECPGN,Etiology of AGN in TCM,Summary,Exogenous ：wind /dampness/sore infection,Internal ：congenital weak physique / acquired weak constitutio
7、n,Pathogenic factor,Questions,Metabolism of water in TCM Oppinion :Tree abundunce and two insufficiency,Pathogenesis of AGN in TCM,Pathogenesis,E T I OGY,Dredge water passage,Transportation/distributionwater,Transformation of qi Water metabolism,Water and dampness accumulated in the skin and muscle
8、Giving rise to edema,LUNGSPLEENKIDNEY,Clinical manifestation,Medical history,Streptococccal infection 1-3 weeks before onset,Clinical manifestation,Symptoms and signs,Edema unpitting Face and eyelid,Clinical manifestation,Symptoms and signs,Oliguria,year normal oliguria anuria 1 400-500 200 1-3 500-
9、600 200 30-50 4-6 600-800 300 7-14 800-1400 400 (ml),12 weeks,Clinical manifestation,Symptoms and signs,Gross hematuria,Microscopic hematuria,Clinical manifestation,Symptoms and signs,Hypertension,blood pressure （mmHg） preschool 120/80 Early school 130/90,（1）30%-80% cases。 （2）resolves within 1-2 wee
10、ks accopany with increasing of amount of urine （3）if very high，be careful of encephalic disease,Clinical manifestation,Red blood cell + Red cast Proteinuria +，,Routine urine examination,Laboratory examination,Clinical manifestation,ASO,Laboratory examination,Positive rate 50%80% Afer infection,ASO t
11、itter begin to increase within 2-3 weeks,the summit is within 3-5weeks ,then decrease slowly in 3-6 months , recovery time in 1 year.,An antibody to streptococcal antigen,Clinical manifestation,C3,Laboratory examination,8090%，Serum C decrease within 2 weeks .recovery after 6-8 weeks Cdetermination i
12、s very important to differentiate between AGN and other types,Severe condition,acute congestive heart failure hypertensive encephalic disease acute kidney failure,early stag（ in 2 weeks）Emergency，need rescue,Essentials for dignosis,Medical history: streptococcal infection like URI or skin infection
13、with in 1-3 weeks Clinical manifestation:edema,oliguria,hematuria, hypertension Lab ：C3 decrease , ASO increase,Syndrome differentiation and treatment,Sthenia , Eliminating first,Common syndromes,Wind and water struggling with each other Internal invasion of dampness Qi deficiency of lung and spleen
14、 supplementary explanation: the first two syndromes can be seen at the early stage of AGN, while qi deficiency of lung and spleen can be seen at the late stage.,Deteriorate syndrome,Water and qi disturbing the heart and lung Pathogenic factors invading Jueyin Internal obstruction of water and toxin
15、supplementary explanation: can be seen at the early stage,Common syndromes,Wind and water struggling with each other,Main symptoms and signs : sudden onsetedema:limbs and eyelids lustrous skin,unpitting edema,dark and scanty urinefever,aversion to coldcoughwhitish and thin furfloating/ tight or rapi
16、d pusle,Therapeutic methods : Dispelling wind and inducing diuresis,Prescription and drugs: Modified mahuang Liaoqiao chixiaodou decocotion,Internal invasion of dampness and heat,Main symptoms and signs : sudden onsetedema:limbs and body ,dark and scanty urineskin sore,fever,thirst,dysphoriachest di
17、stress,thoracic fullnesspoor appetite,nauseared tongue,yellow and thin furslippery and rapid pusle,Therapeutic methods : Clearing away heat and Moving toxin,removing dampness to relieve edema,Prescription and drugs: Sanmiao pill in combination with daochi power,Qi deficiency of the lung and spleen,M
18、ain symptoms and signs : be seen in late stage inapparent edema or no,disappearance of hematuriaprofuse sweat lustreless or pale complexionlassitude,hypodynamiapale tongue with whitish furslow and weak pusle,Therapeutic methods : Strengthening the spleen Supplementing qi,Prescription and drugs: Modi
19、fied shenling baizhu power In combination with yupinfen power,Water and qi superiorly disturbing the heart,Main symptoms and signs : be seen in early stageedema:limbs and body ,cough with short breath,palpitation,chest distresscyanotic lips ,dysphoriainability to lie flatwhitish and greasy furrapid
20、pusle without force,Therapeutic methods : Purging the lung and expelling water,warming yang and enhence body resistance,Prescription and drugs: Modified jijiao lihuang pill,Pathogenic factors invading jueyin meridian,Main symptoms and signs : be seen in early stage headache,vertigoblur vision,dyspho
21、riaaccidental syncopeclonic convulsionred tongue,yellow and rough furtaut pusle,Therapeutic methods : Clearing away heat Calming the liver Suppressing yangPurging fire and heat,Prescription and drugs: Modified longdan xiegan decoction,Internal stagnation of water and toxin,Main symptoms and signs :
22、be seen in early stagegeneral edema ,scanty urine or anuriadizziness,headache,nausea,vomiting,even comagreasy fur and taut pusle,Therapeutic methods : Expelling the exterior pathogenic factors with pungent drugs and clearing the interior heat with bitter drugs so as to remove filth and toxin,Prescri
23、ption and drugs: Modified wendan decoction In combination with fuzhi xiexin,case analysis XX，M，6 year old。chief complaint：Edema and fever for 6 days。 Diagnosis is AGNNow the sympotoms and signs：face edema,fever,aversion to cold ,thirst,sore throat, scanty urine and hematuria,red tongue,whitish and t
24、hin fur,rapid and floating pusle.questions：1、diagnosis (TCM)2、 Therapeutic methods 3、 Prescription and drugs:,Review,The definition of AGN Essential for diagnosis Etiology and pathogenesis The therapeutic methods of “internal invasion of dampness and heat”,and the prescriptionsThree deteriorate syndrome,THANKS,
