丁小强-肾小球疾病.ppt

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1、肾小球疾病GlomerularDiseases丁小强复旦大学附属中山医院Pathologicalchanges--glomerularinjuryClinicalmanifestations--proteinuria/hematuriaAgroupofdiseasesComplicatedcauses&mechanismsVariousclinicalmanifestationsDifferentprognosisMultipletreatmentprimaryglomerulardiseasessecondaryglomerulardiseaseshereditaryglo

2、merulardiseasesImmunemechanismsHumoralCell-mediatedNon-immunemechanismsInflammationGlomerulardiseasesA.Immunemechanisms(A)depositsofCirculatingImmuno-Complex(CIC)circilationantigen+antibodyCICkidneyCIC/depositsantigenextrinsicdrugs--nonhomologousserum,penicillinfoods—xenogenicproteinpathoge

3、n—specificserotypesstreptococci,HBV,HCVintrinsicnucleus（SLE)cytoplasm（ANCA）cellularmembraneantigenoftumorantigenofthyroidWhydoesCICdepositintheglomeruli?Largeareaofglomerrularcapillaries--morechancestocontactNetstructureofCIC--easytodepositandsettledownClearancedysfunctionofmesangialcells,d

4、isabilityofmononuclearmacrophage,componentorfunctiondefectofcomplementsDecreaseclearanceofCIC(B)insituImmunocomplex1.Nativerenalantigenglomerularbasementmembrane+anti-glomerularbasementmembraneantibody(anti-glomerularbasementmembraneglomerulonephritis)2.AntigenstrappedorplantedDNA+anti-DNAa

5、ntibody(LupusNephritis)BalancebetweenthedepositandclearanceofICdeterminesthesituationofthediseasesPersistenceofantigenClearancedysfunctionofmesangialcellsdisabilityofmononuclearmacrophagecomponentorfunctiondefectofcomplementsICdeposit>clearanceB.Cell-mediatedimmunemechanismsminimalchangeglo

6、merulopathy?C.Non–immunemechanismsglomerularhypertensionhyperlipidemia(LDL-Cho)advancedglycosylationendproducts(protein)glomerulosclerosisInflammationMediatorsofinflammationAgroupofmoleculeswhichactasmediatorsofinflammationandcomplicatedbiologicalfunctionOriginofinflammationmediatorsinkidne

7、yExtrinsicCellsinkidneyinfiltrativeneutrophil,lymphocyte,mononuclearmacrophage,plateletIntrinsiccellsinkidneyMesangialcells,tubularcells,endothelialcellsMediatorsofinflammation-activeoxygenandactivenitrogen-lipids-complements-cytokines-chemotaticfact