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Glomerulonefrita acuta postinfectioasa

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Glomerulonefrita acuta postinfectioasa =glomerulopatii ale copilului caracterizate prin aparitia, dupa o infectie acuta,a GN manifestata prin: – PowerPoint PPT presentation

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Title: Glomerulonefrita acuta postinfectioasa


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,Stafiloco
    c,meningococ
  • virusiadeno,echo,mixo,varicela,rujeola,urlian
  • ricketsii,fungi,paraziti

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  • 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 complementmodif.perm.MB
  • activ.F12-microtromboze
  • oligurie,HTA
  • CLINICAB,3-13 a(5-10)
  • infectie streptococica cu 2-3 sapt
    ant.
  • per.latenta asimptomatica
  • per.stare4 sindroame

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  • Sindromul urinaroligurielt300ml/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 gt
  • Sindromul de retentie azotata gturee,creatinin
    a,ac.uric
  • Sindromul edematosedeme renale-albe,moi,
    pufoasefata,pleoape gtG
  • Sindromul hipertensivHTA mixta,moderata
  • EPA

  • HTIC(pseudoeclampsia uremica)
    !!FO-edem,staza

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  • alte ex.labltCST si C3
  • gtVSH,Fg,CRP
  • ltNa,gtK(T inalt,ascutit pe EKG)
  • prezenta CIC
  • gtASLOgt400uTodd
  • TRATAMENTrepaus la pat
  • restrictie Na, K, H20 (500
    ml diureza zilei precedente)
  • regim glucidic
    (gem,miere,zahar)
  • lipidic
    (frisca,smintina,unt)
  • restrictii
    proteice uree gt 75mg/dl---prot.vegetale---prot.ani
    male

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  • eradicarea infectiei strept Pen G,10zile
  • IRA, HTA furosemid, diazoxid,
    hidralazina/nifedipin/captopril, enalapril dializa

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SINDROMUL NEFROTIC
  • sdr.clinico-biologic - edeme generalizate
  • - proteinurie
    gt0,1g/kg/zi masiva,lipidurie,oligurie
  • - hipoproteinemie
    cu disproteinemie(ltalb, gammaglob, gtalfa2,
    betaglobulinele)
  • CLASIFICARE primitiv/secundar
  • pur/impur (hematurie,
    HTA, retentie azotata)

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  • SINDROMUL NEFROTIC IDIOPATIC(PUR)
  • B/F2/1
  • 9l-6a
  • debut paloare, modif. comportament, inapetenta,
    g, v, diaree, oligurie, edeme
  • per de stare edeme masive, ascita, hidrocel,
    hidrotorax
  • oligurielt300 ml/zi
    manif. digestive (anorexie,
    diaree, d. abd)
  • malnutritie, TA normala
  • LABORATOR proteinuriegt0,1g/kg/zi selectiva
    (GMlt100.000 albumina, siderofilina)
  • lipidurie-corpi lipoizi
  • ltNa,gtK urinar
    (hiperaldosteronism sec)

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  • singe-hipoproteinemielt5,6g/dl
  • -hipoalbuminemielt2,5g/dl
  • ltgammaglob,transferina
  • gtalfa2,betaglob
  • modif.raport alb/globuline
  • lipide totale,Col,TGgt(ser lactescent)
  • ltCa(fract legata de prot)
  • gtVSH
  • uree,creat,aslo,CS-normale
  • COMPLICATIIinfectii-bacteriene(peritonita,cutanat
    e,respiratorii,ITU),
  • virale
  • tromboze,malnutritie
  • complic corticoterapiei

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  • TRATAMENTrepaus la pat
  • regim hiposodat,restrictie
    lipide,glucide(4-8g/kgc/zi),proteine(3g/kgc/zi)
  • prevenirea
    infectiilor,ingrijirea pielii
  • diureticefurosemid1-2
    mg/kg/zi
  • albumina umana
  • corticoterapia2mg/kgc/zi(6
    0mg/m2 sc/zi) 4 saptamini continuu----4 sapt
    discontinuu,actual s e scade progresiv doza inca
    4 sapt

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  • SN-corticosensibil(90-95)
  • -corticorezistent
  • -corticodependentimunosupresoare-ciclofosfam
    ida1-3 mg/kgc/zi
  • azathioprina1-2 mg/kgc/zi
  • clorambucil 0,2mg/kgc/zi

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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,Enterobacte
    r
  • -Proteus,Piocianic
  • fungi(Candida),virusuri,protoz.(Trichomonas)
  • calea de patrundere-ascendenta(retrouretrala)

  • -descendenta(hematogena)
  • -contiguitate?
  • fact.favF,igienalt,raporturi sexuale,sarcina,RVU,
    litiaza,malformatiile(fimoza,VUP),DZ,constip.

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  • CLINICAsdr.urinar(disurie,polakiurie,hematurie,en
    urezis,tenesme vezicale)
  • sdr infectios(gtgt la
    copilltlt)-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(gtincid la F)-anorexie,varsaturi,dureri
    abdominale,diaree,
  • -febra(!sdr febril
    prelungit)
  • -polakiurie,urini
    fetide,pateaza scutecul
  • copilgt(F/B 10-30/1) simpt generaleltlt iar
    simpt.urinaregtgt
  • PNC-HTA,nanism renal

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  • LABORATOR-urocultura
  • gt100000 UFC/ml
  • -lt10000 UFC/ml
  • Suspiciune 10000-100000UFC/ml
  • 3 uroculturi cu acelasi germenedg
  • leucocituria gt25 leuc/mm3 F
  • gt50 leuc/mm3 B
  • ITU inaltagtVSH,Fg,CRPureee,creatinina
  • ecografie,cistouretrografia mictionala,UIV,Rx.abd
    pe gol,scintigrafia renala

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  • 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
  • ampicilinaaminoglicozid(3-5-7mg/kgc)
  • cefalosporina 3
  • ciprofloxacina 15-25 mg/kgc/zi
  • acidifierea urinii(vit.C)
  • urocultura la 48-72 ore

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  • 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(corecti
    e malformatii,antireflux)

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INTOXICATIA CU ORGANO-FOSFORATE
  • Mecanism-inhibarea colinesterazelor si acumularea
    acetilcolinei la nivelul sinapselor colinergice
  • Compusiparation,malation(toxice de
    lupta,actualmente insecticide)
  • fructe si legume nespalate

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  • 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

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LABORATOR-dozarea activitatii colinesterazei-intox
.usoare(20-50din N)
medii(10-20din N)
grave(lt10din N)
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  • TRATAMENT-decontaminare cutanata(apa,sapun)
  • instil. conjunctivale
  • digestiva(carbune la lt4-6 ore de la ingestie)
  • -sustinerea functiilor
    vitale
  • O2,IOT
  • diuretice,cardiotonice
  • diazepam
  • terapie hidroelectrolitica si acido-bazica
  • -atropina f
    1ml1mg
  • 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

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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

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  • Substante-soda caustica,lesia de sapun,apa de var
  • zoneMoldova,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 esofagieneanemie,malnut
    ritie
  • TRATAMENTin perioada acuta Atbcorticoterapie
  • Ulterior-dilatatii esofagiene cu bujii
    flexibile,pe cale endoscopica
  • -gastrostomie(paleativ)
  • -esofagoplastie cu tub gastric

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