Glomerulonefrita acuta postinfectioasa

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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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