经典泌尿系统疾病.ppt

经典泌尿系统疾病; Diseases Of Urinary System;Case 1 ，male，33 years old.He discovered his urine is red(hematuria)when pissing 3 days ago. What disease is he suffering from? Disease of Urinary system? Inflammatory disease? （nephritis、pyelonephritis、 cystitis）？ Neoplasm? （renal carcinoma?、 cancer of bladder)? calculus? tuberculosis？ other diseases?; Contents： Glomerulonephritis; GN Pyelonephritis Tumor of kidney and bladder ;Review Nephron Glomerulus Glomus ● Filtering membrane ● Mesangium Bowmans capsule Renal tubule ;Gross;renal tubule;Mesangium ：Mesangial cell Mesangial matrix;the relationship of the capillary loops to the mesangium Mesangium ：Mesangial cell Mesangial matrix;Filtering membrane ;;filtration membrane;;滤过膜滤过作用与其结构和电荷有关 1、体积依赖性屏障作用： 一般情况下，69kD的白蛋白可少量滤过，150~200kD的免疫球蛋白则阻止在基膜内。 2、电荷依赖性屏障作用：滤过膜带负电荷;一、发病机制 （ Pathogenesis ） The immune complex is the most important cause 属于Ⅲ型变态反应 抗体：IgG、IgA、IgM 抗原：非球性、球性; （一）、循环免疫复合物沉积 Circulating immune complex deposition Ag（非球性）+ Ab = IC，随血流经肾脏时而沉积在肾小球的系膜区、内皮细胞下、基底膜内和上皮细胞下，是否沉积与它的大小、电荷有关。;Subepithelial deposits;① Mesangium;granular pattern; （二）原位免疫复合物形成 In situs immune complex deposition A: anti-GBM nephritis：chain α3 of type Ⅳcollagen B: Heyman’s nephritis ：meglin complex megalin+RAP (Receptor associated protein) in podocyte C: antibody against the planted antigens ;Antigen;Anti-GBM nephritis： linear pattern;IC沉积于滤过膜上 ; ;3.慢性肾炎综合征 Chronic nephritic syndrome 4.反复发作性或持续血尿 Asymptomatic hematuria or proteinuria 5. 隐匿性肾炎综合征 occult nephritis syndrome 6. 肾功能衰???和尿毒症 Azotemia Uremia;尿改变;三、基本病变;HE Staining ：normal glomerulus