内科学 肾小球疾病 ppt课件

《内科学 肾小球疾病 ppt课件》由会员上传分享，免费在线阅读，更多相关内容在教育资源-天天文库。

1、GlomerularDiseasesForInternalMedicine1医学Theperipheralportionofaglomerularlobule2医学GlomerularDiseasesClassificationPrimarySecondaryHereditary3医学Pathogenesis4医学ImmunologicglomerularinjuryHumoralantibody-mediatedCellularantibody-independent5医学Antibody-mediatedCirculatingautoantibodie

2、swithintrinsicautoantigens:eg.anti-GBMdiseaseInsituformationofimmunecomplexs/circulationgantibodieswithextrinsicantigensthathavebeen“planted”withintheglomerulus:eg.PostinfectiousglomerulonephritisANCA/AECAassociated:nodisernibleimmunecomplexesintheglomerularparenchyma6医学Cellularan

3、tibody-independentglomerularinjuryLesswelldefinedInitiatorsofinjuryinpauci-immuneglomerulonephritis,whichsharethedownstreammediatorswiththeantibody-dependentinjurySolublefactorsfromTcells:inMCDandprimaryFSGS7医学NonimmunologicglomerularinjuryMetabolicHemodynamictoxic8医学immunologichu

4、moralcellularnon-immunologicinflammationGlomerularinjury9医学Clinicopathologiccorrelatesinglomerulardisease10医学Majorclinicopathologicentities(cont’d)NephroticsyndromeGlomerularfiltrationbarrieraffectedNephrotic-rangeproteinuria>=3.5g/24hHypoalbuminemia,edema,hyperlipidemia,andlipidu

5、ria,andaprothromboticstateMembranousglomerulopathyMinimalchangedisease(MCD)FSGSMembranoproliferative:hybridlesionofnephriticandnephroticfeatures11医学OthersGlomerulardepositiondiseases:extravasculardepositionofparaproteinorfibrillarmaterialThromboticmicroangiopathies:thrombiwithinth

6、erenalmicrovasculature12医学PrimaryinsultInflammatory√Metabolic√Hemodynamicormechanic√ToxicInfectiousMayoverlapMayinducesimilarclinicopahtologicpresentations13医学病变部位系膜mesangium系膜细胞mesangialcell系膜基质mesangialmatrix基膜basementmembrane上皮细胞足细胞podocyte、足突footprocess内皮细胞14医学Theperipheralpor

7、tionofaglomerularlobule15医学基本病变增生proliferation硬化sclerosis16医学1.轻微肾小球病变（MinorLesion)无特异性病变光镜下可见轻度系膜细胞增生和系膜基质增多轻微病变肾病minimalchangedisease，MCD轻度系膜增殖性肾小球肾炎毛细血管内增殖性肾小球肾炎恢复期其它17医学MCD（左）正常，（右）上皮细胞足突广泛融合、消失18医学2.局灶节段性病变(1)局灶节段性增殖性肾小球肾炎focalandsegmentalproliferativeglomerulonephritis(2)局

8、灶节段性肾小球硬化focalandsegmentalglomeru