狼疮性肾炎课件.ppt

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1、狼疮性肾炎免疫学检查病因与发病机制临床表现狼疮性肾炎病理改变预后诊断和治疗FactorsassociatedwithdevelopmentofsystemiclupuserythematosusSunlightDrugs:>100describedinassociationwithdruginducedlupusEpstein-BarrvirusAbnormalitiesofapoptosisAbnormalsignaltransduction:tolllikereceptorsCytokinepatterns:interferonsignature;dec

2、reasedinterleukin2fromTcellsGenes:CRPandserumamyloidPgenes,FcγRreceptors,programmedcelldeathOccupationalexposure:silica,pesticides,mercuryLN的发病机制抗DNA抗体和免疫复合物诱导肾脏损伤B淋巴细胞产生具有致病性的抗DNA抗体等自身抗体体内核小体增多或异常核小体出现辅助性T淋巴细胞参与激活B淋巴细胞TheglomerularpatternsofinjuryinSLE.Internationalsocietyofnephrol

3、ogy/renalpathologysocietyclassificationoflupusnephritis(2003)ClassDescriptionClassIMinimalmesangiallupusnephritisNormalatlightmicroscopyMesangialdepositsonimmunofluorescenceClassIIMesangialproliferativelupusnephritisMesangialhypercellularityorexpansionwithmesangialimmunedepositsSome

4、subepithelialorsubendothelialdepositsonimmunofluorescencebyelectronmicroscopyClassIIIFocallupusnephritisInvolves<50%glomeruli.ActiveorinactivelesionstypicallywithsubendothelialdepositsA:Activelesions;focalproliferativelupusnephritisA/C:Activeandchroniclesions;focalproliferativeandsc

5、lerosinglupusnephritisC:Chronicinactivelesionswithglomerularscars;focalsclerosinglupusnephritisClassIVDiffuselupusnephritisInvolves>50%glomeruli.Activeorinactivediffuse,segmentalorglobalendo-orextracapillaryglomerulonephritis.Typicallywithsubendothelialdeposits.Dividedintodiffuseseg

6、mental(S)when>50%ofinvolvedglomerulihavesegmentallesionsanddiffuseglobalwhen>50%ofinvolvedglomerulihavegloballesionsS(A):Activelesions;diffusesegmentalproliferativelupusnephritisG(A):Activelesions;diffuseglobalproliferativelupusnephritisS(A/C):Activeandchroniclesions;diffusesegmenta

7、lproliferativeandsclerosinglupusnephritisG(A/C):Activeandchroniclesions;diffuseglobalproliferativeandsclerosinglupusnephritisS(C):Chronicinactivelesionswithscars;diffusesegmentalsclerosinglupusnephritisG(C):Chronicinactivelesionswithscars;diffuseglobalsclerosinglupusnephritisDiffuse

8、proliferativeglomer