泌尿系统疾病医学课件

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1、TheDiseasesofTheUrinarySystemDepartmentofPathology,XiangyaMedicalCollege,CSUContents：Glomerulonephritis;GNPyelonephritisTumorofkidneyandbladder尿改变尿量尿质少尿、无尿多尿、夜尿血尿蛋白尿管型尿水肿、高血压氮质血症尿毒症CortexMedullaPelvisrenaltubuleglomusBowman'scapsulePathogenesisItisakindofallergydiseasethatmainlyd

2、amageglomerulus.Classification:PrimarySecondary1.InsituimmunecomplexdepositionAntibodiesreactdirectlywithfixedorplantedantigensintheglomerulus.★Anti-GBMnephritis★Heymannnephritis★AntibodiesmayalsoreactinsituwithantigensofplantedAnti-GBMnephritis：linearpattern2.Circulatingimmuneco

3、mplexdeposition①Mesangium②Subendothelial③Subepithelial④GBMICdepositionEM:ImmunecomplexisalsocalledelectrondensedepositsgranularpatternⅢ.Pathologicdiagnosis●Renalneedlebiopsy●LM：HEStaining.SpecialStaining：PASPASMMasson●Immunofluorescence：IgG、IgM、IgA、C3●EMⅣ.Basicpathologicalchanges

4、1.肾小球细胞增多2.基底膜增厚和系膜基质增多3.炎性渗出和坏死4.玻变、硬化HEStaining：normalglomerulushypercellularityGBMbecomethickHyalinization&sclerosisⅥ.ClassificationAcutediffuseproliferativeGNRapidlyprogressiveGNMembranousGNMinimalchangedisease,MCDFocalsegmentalglomerulosclerosis,FSGSMembranoproliferativeGNMe

5、sangialproliferativeGNIgAnephropathyChronicGN（一）急性弥漫性增生性肾炎AcutediffuseproliferativeGNPostinfectiousGN1.病因、发病机制A族乙型溶血性链球菌中致肾炎菌株（12、4和1型）.HEStaining：normalglomerulusproliferativeendothelial&mesangialcellsHumpIgG-ir2.病变（1）大体：大红肾redlargekidney、蚤咬肾（2）光镜：内皮细胞和系膜细胞增生（3）免疫荧光:颗粒状荧光IgG、C3沉

6、积（4）电镜：增生+上皮下电子致密沉积物（驼峰状“hump”）3.临床病理联系Acutenephriticsyndrome（1）（2）（3）（二）、快速进行性肾小球肾炎RapidlyprogressiveGN,RPGNExtra-capillaryGN1、病理变化:（1）光镜：﹡概念：新月体(Crescent)﹡分为几个阶段?﹡如何形成？﹡对肾功能有何影响?﹡诊断?新月体形成的肾小球数>50%（2）电镜：GBM严重受损：断裂、缺损。2、临床表现：Rapidlyprogressivenephriticsyndrome新月体(Crescent):由增生的壁层

7、上皮细胞、单核细胞和炎症细胞构成,附着在肾球囊层，在血管球外侧形成新月形或环状结构。CellularCrescentCellularCrescentRapidlyprogressiveglomerulonephritis.ElectronmicrographshowingcharacteristicwrinklingofGBMwithfocaldisruptionsinitscontinuity3、病因、分类Ⅰ型RPGN：抗肾小球基底膜性肾炎。肺出血肾炎综合征Goodpasturesyndrome抗GBM抗体与肺泡基底膜交叉反应，咯血、血尿、蛋白尿、轻度

8、高血压、肾衰。Ⅱ型RPGN：免疫复合物性肾炎。Ⅲ型RPGN：原因不明，血管炎，较