MindMap Gallery Medicine-Urology Disorders
Pediatric urinary system diseases, including anatomical and physiological characteristics of children’s urinary system, Clinical classification of glomerular diseases in children, acute glomerulonephritis, etc.
Edited at 2023-12-12 09:16:20One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
Project management is the process of applying specialized knowledge, skills, tools, and methods to project activities so that the project can achieve or exceed the set needs and expectations within the constraints of limited resources. This diagram provides a comprehensive overview of the 8 components of the project management process and can be used as a generic template for direct application.
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
Project management is the process of applying specialized knowledge, skills, tools, and methods to project activities so that the project can achieve or exceed the set needs and expectations within the constraints of limited resources. This diagram provides a comprehensive overview of the 8 components of the project management process and can be used as a generic template for direct application.
urinary tract disease
Anatomy and physiological characteristics of children's urinary system
anatomical features
Kidneys (the younger you are → the heavier the kidneys are) (lower position)
Ureter (baby oil ureter is long and curved → underdeveloped and prone to infection)
Bladder (positioned higher than in older children → palpable when urine is full)
Common parts of hydronephrosis in children (renal pelvis and ureter) → there is a stricture in the connection here
Physiological characteristics
Kidney function (urine formation around 12 weeks)
Concentrate and dilute functions
The dilution function is the same as that of adults
Low filtration rate and poor Na excretion ability → prone to edema and Na retention
Poor concentration function
Clinical classification of glomerular diseases in children
primary glomerular disease
glomerulus nephritis
Acute glomerulonephritis (three highs and zero lows)
Mainly blood in urine ( )
Hematuria Proteinuria
edema high blood pressure
★No hypoalbuminemia
Rapidly progressive glomerulonephritis
Nephrotic syndrome (ps: the absence of the two key factors of hypoalbuminemia and proteinuria can exclude nephrotic syndrome)
Simple nephrotic syndrome (three highs and one low)
massive proteinuria
hypoalbuminemia
Hyperlipidemia
High degree of edema
Nephritic nephrotic syndrome (three highs and one low nephritis manifestations)
Urinary RBC red blood cells ≥ 10 more than 3 times within 2 weeks
recurrent hypertension
renal insufficiency
hypocomplementemia
Mainly proteinuria ( )-( )
Classification according to hormonal response
Hormone-sensitive type→Treatment time ≤4 weeks, urine protein turns negative
Hormone-resistant type→Urine protein remains positive after 4 weeks of treatment
Hormone-dependent → Sensitive to hormones, but dose reduction >2 times/relapse occurs within 2 weeks of drug withdrawal
Acute glomerulonephritis (acute nephritis) (acute post-streptococcal nephritis)
Brief description
Overview of the mechanism (decreased glomerular filtration rate → water and sodium retention → water cannot enter blood vessels → non-depressed)
Pathogenesis
Streptococci activate complement → glomerular inflammatory lesions → glomerular inflammation
Proliferative lesions → Endothelial cell swelling → Capillary occlusion → Decreased glomerular filtration rate → Tubulotubular imbalance (oliguria or anuria) → water and sodium retention
Edema
hypertension
circulatory congestion
glomerular basement membrane disruption
proteinuria
hematuria
Cast urine
Cause
Acute infection with group A beta-hemolytic streptococci → immune complex glomerulonephritis
pathology
Early stage (intracapillary proliferative nephritis)
Electron microscopy shows hump-like precipitation of electron-dense material under glomerular epithelial cells.
clinical manifestations
Precursor infection (most of them have a history of streptococcal infection → may have elevated aso) (mainly respiratory tract infection)
Typical performance
Edema
The face appears first
Downside
Non-pitted (water factor ★ nephrotic syndrome → pitted {protein factor})
Hematuria (major)
proteinuria
hypertension
decreased urine output
Serious symptoms (a few have them)
severe circulatory congestion
Reason → (water and sodium retention, increased plasma volume)
diagnosis
Shortness of breath/difficulty breathing
Wet rales/pink frothy sputum in the lungs
orthopnea
jugular venous distention
Cardiomegaly/gallop rhythm
Hepatomegaly/edema
Hypertensive encephalopathy
Cause→(Cerebral vasospasm)
diagnosis
hypertension
Headache and vomiting
Diplopia
transient blindness
convulsions and coma
acute renal insufficiency
Oligouria
azotemia
electrolyte imbalance
Acid substitute
atypical performance
Only complement C3 is reduced
Microscopic hematuria
laboratory tests
Urinary protein -
elevated aso
Complement C3
Diagnosis and identification
diagnosis
strep infection
hematuria proteinuria
Edema, hypertension
elevated aso
C3 decreases
Identify iga nephropathy
Mainly hematuria
No edema/hypertension
Complement C3 is normal
treat
★Glomerulonephritis is self-healing
Circulatory congestion → first choice → furosemide
Cerebral edema/pulmonary edema→Sodium nitroprusside (vasodilator)★If there is convulsion first→Diazepam to stop convulsion
Refractory (dialysis)
Use penicillin when there is an infection focus
If there are no special serious symptoms → focus on rest and infection control
prognosis
Can get out of bed → Gross hematuria and edema disappear
Can go to school → ESR is normal
Can do physical work → normal urine test
Good prognosis → self-healing
nephrotic syndrome
Overview (increased glomerular basement membrane permeability) → a large amount of protein in plasma is lost in urine
Characteristics (massive proteinuria, hypoalbuminemia, hyperlipidemia, significant edema)
★Massive proteinuria and hypoalbuminemia are necessary conditions
Pathophysiology
Basic lesion → increased glomerular permeability
secondary changes
Hypoalbuminemia/massive proteinuria
Large amounts of plasma protein are lost from the urine
Filtered out from the glomerulus and broken down
Liver protein synthesis decreases and protein breakdown accelerates
Hyperlipidemia
Edema
hypoalbuminemia
Low plasma colloid osmotic pressure
clinical manifestations
Edema
eyelids to whole body
concave type
Have pleural and abdominal effusion
Three high and one low
High degree of edema
High proteinuria → albumin (mainly albumin loss) ★Egg protein is white
Hyperlipidemia
Hypoalbuminemia →<25g/L
complication
Infect
Mainly upper respiratory tract infection
Electrolyte imbalance and hypovolemia (common ones include low Na, low K, and low Ca)
Excessive use of diuretics
infection vomiting diarrhea
Hyponatremia
Thrombosis (nephrotic syndrome → hypercoagulable state → arteriovenous thrombosis)
Renal vein thrombosis ★ common (treatment: heparin or urokinase thrombolysis)
Sudden low back pain
Hematuria occurs
Oliguria
kidney failure
deep veins of lower limbs
Edema of both limbs varies and does not change with body position
Ascites
Lower limb pain with disappearance of dorsalis pedis artery pulse
laboratory tests
First choice (complement C3) → normal value: 0.8-1.2
Simple nephrotic syndrome (minimal change nephrotic syndrome) → normal C3
Nephrotic nephrotic syndrome→decreased C3 complement
Treatment (mainly glucocorticoids)→prednisone methylprednisolone ★Micro-small lesions (simple nephrotic syndrome) → most sensitive to glucocorticoids
★One " " is equal to 10 red blood cells/per hp
The difference between simple and nephritic nephropathy
Is there hematuria?
Do you have high blood pressure?
Whether there is hyperlipidemia
hypocomplementemia