内科学 肾小球疾病-丁小强教案.ppt

Glomerular Diseases For Internal Medicine Glomerular Diseases Classification Primary Secondary Hereditary Pathogenesis Immunologic glomerular injury Humoral antibody-mediated Cellular antibody-independent Antibody-mediated Circulating autoantibodies with intrinsic autoantigens: eg. anti-GBM disease In situ formation of immune complexs/ circulationg antibodies with extrinsic antigens that have been “planted” within the glomerulus: eg. Postinfectious glomerulonephritis ANCA/AECA associated: no disernible immune complexes in the glomerular parenchyma Cellular antibody-independent glomerular injury Less well defined Initiators of injury in pauci-immune glomerulonephritis, which share the downstream mediators with the antibody-dependent injury Soluble factors from T cells: in MCD and primary FSGS Nonimmunologic glomerular injury Metabolic Hemodynamic toxic Clinicopathologic correlates in glomerular disease Major clinicopathologic entities (cont’d) Nephrotic syndrome Glomerular filtration barrier affected Nephrotic-range proteinuria =3.5g/24h Hypoalbuminemia, edema, hyperlipidemia, and lipiduria, and a prothrombotic state Membranous glomerulopathy Minimal change disease (MCD) FSGS Membranoproliferative: hybrid lesion of nephritic and nephrotic features Others Glomerular deposition diseases: extravascular deposition of paraprotein or fibrillar material Thrombotic microangiopathies: thrombi within the renal microvasculature Primary insult Inflammatory√ Metabolic √ Hemodynamic or mechanic √ Toxic Infectious May overlap May induce similar clinicopahtologic presentations 1.轻微肾小球病变（Minor Lesion) 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 minimal change disease，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 2. 局灶节段性病变 3.弥漫性肾小球肾炎 (diffusive glomerulonephritis) 系膜毛细血管性肾小球肾