继发性肾小球肾炎.ppt
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继发性肾小球肾炎
IgA肾病或肾小球肾炎
? 病因发病机制：粘膜损伤→ IgA形成 →含IgA的大分子的免疫复合物沉积于肾小球
? 病变特点：
- 免疫病理：以IgA为主的免疫球蛋白和C3沉积于系膜区。
- 光学显微镜：局灶性或弥漫性的，除膜性肾小球肾炎以外的各型肾小球肾炎。
? 临床表现：可出现血管炎和紫癜及各型肾炎综合征。
狼疮性肾炎
? 病因发病机制：自身免疫性疾病。含抗核抗体、抗细胞浆抗体、抗球蛋白抗体、抗细胞膜抗体等多种免疫复合物，沉积于肾小球
? 病变特点：
- 免疫病理：含IgG、IgA、IgM、C3、C4、C1q的多种免疫复合物，沉积于肾小球的各个部位。
- 光学显微镜：局灶性或弥漫性的，各型肾小球肾炎。
? 临床表现：可出现全身(心、肝、脑、关节、皮肤等)多系统病变及各型肾炎综合征。
各型GN的演变关系
毛细血管内增生性GN
膜增生性GN
局灶性GN
系膜增生性GN
微小病变性GN
KEY WORD
? glomerulinephritis, Endocapillary proliferative GN, Membranous GN,? Mesangioproliferative GN, Membranoproliferative GN, Crescentic GN,? Minimal change GN, Focal GN, Sclerosing GN
三、急性肾小管坏死
( acute tubular necrosis )
由于休克或中毒导致的肾小管上皮细胞坏死，主要侵犯各段肾小管，主要临床表现为少尿、无尿和肾功能衰竭。
肾小球缺血
肾小球滤过率 肾小管上皮坏死 细胞碎片堵塞
尿液返流肾间质水肿
少尿或无尿
后期，再生的肾小管上皮功能不全 多尿和等比重尿
CONCLUSION
? Acute tubular necrosis: tubular epithelial cells show diffuse coagulation necrosis, caused by renal ischemia or poisoning, often occur acute renal failure.
? KEY WORD: Acute tubular necrosis
四、肾盂肾炎( pyelonephritis )
病原体感染直接引起的化脓性炎，主要侵
犯肾盂粘膜和肾间质，主要临床症状有急性感
染的全身症状、血尿、白细胞尿或脓尿、下尿
路刺激征。
? 急性肾盂肾炎：脓性卡它性炎；肾的蜂窝织炎；肾脓肿上行性感染者，近肾盂处严重，肾皮质轻,单肾发病或双肾分布不均血源性感染者，双肾弥散分布，以肾小球为中心形成小脓肿。
? 慢性肾盂肾炎；淋巴和单核细胞浸润；肉芽组织形成,结缔组织增生；厚壁脓肿；肾盂变形;瘢痕肾形成。
CONCLUSION
? Pyelonephritis: is a suppurative inflammation, is caused by infection of suppurative bacterium. The pelvis, interstitium and tubules is major injury site. Morphology:focal suppurative inflammation (phlegmonous inflammation or abscesses).Its clinical manifestations include: fever, malaise, flank pain, dysuria,frequency and urgency, pyuria and white cell casts.
五、过敏性间质性肾炎
( allergic interstitial nephritis )
概念：
各种过敏因素导致的非化脓性炎症，主要侵犯肾间质,主要的临床症状是肾功能损伤乃至肾功能衰竭。
病因发病机制：药物和其他过敏原导致IV型变态反应
CONCLUSION
? Allergic interstitial nephritis: is a nonsuppurative inflammation, is caused by drug allergy. The interstitium and tubules is major injury site. Morphology: mononuclear cells (lymphocytes and mono-phagocytes) and/or eosinocytes diffuse infiltrate in interstitium of both kidneys, so often occur acute renal failure.
? KEY WORD: Pyelonephritis,Allergic interstitial nephritis
六、肾脏肿瘤
(1) 肾细胞癌( renal cell carcinoma )
组织发生：近端肾小管上皮细胞
病理特点：位于肾皮质,切面黄色;富含透明胞浆的癌细胞呈巢索状排列。
生物性特性：中老年好发；因血管丰富，可早期血行转移至肺、骨。
CONCLUSION
? Renal cell carcinoma: Histogenesis: proximal tubular cells. Morphology: clear-cancerous cells and trabecularism. Clinical features: renal neoplasm and hematuria occur in 60th and 70th decades of men. Behavior: malignant tumor, often hematogenous metastasis.
(2) 肾母细胞瘤
( nephroblastoma, Wilm tumor )
组织发生:肾胚芽组织
病理特点:肾内巨大肉瘤样肿块;由未分化的胚芽组织、间胚叶性间质和幼稚的肾小球和肾小管组成
生物学特性:婴幼儿好发;早期血行转移至肺、肝等
CONCLUSION
? Nephroblastoma (Wilm's tumor):Histogenesis: renal blastem. Morphology: blastem tissue, abortive glomeruli and tubules, mesenchymal tissue. Clinical features: renal neoplasm and hematuria occur in 2-4 years childhood. Behavior: malignant tumor, often hematogenous metastasis.
七、尿路上皮肿瘤
组织发生:移行上皮细胞
病理特点:
移行上皮乳头状瘤:
与正常移行上皮相似的肿瘤组织呈乳
头状伸出性生长
CONCLUSION
? Urothelial tumors:Histogenesis: transitional cells. Morphology: papilloma and various grades carcinoma. Clinical features: hematuria occur in adult and old men. Behavior: benign papilloma easily recur and become malignant, transitional carcinoma which is often multi-focus growth, and progresisive infiltration, invasion and destruction of the surrounding tissue.
? KEY WORD: Renal cell carcinoma, Nephroblastoma, Urothelial tumors
继发性肾小球肾炎
IgA肾病或肾小球肾炎
? 病因发病机制：粘膜损伤→ IgA形成 →含IgA的大分子的免疫复合物沉积于肾小球
? 病变特点：
- 免疫病理：以IgA为主的免疫球蛋白和C3沉积于系膜区。
- 光学显微镜：局灶性或弥漫性的，除膜性肾小球肾炎以外的各型肾小球肾炎。
? 临床表现：可出现血管炎和紫癜及各型肾炎综合征。
狼疮性肾炎
? 病因发病机制：自身免疫性疾病。含抗核抗体、抗细胞浆抗体、抗球蛋白抗体、抗细胞膜抗体等多种免疫复合物，沉积于肾小球
? 病变特点：
- 免疫病理：含IgG、IgA、IgM、C3、C4、C1q的多种免疫复合物，沉积于肾小球的各个部位。
- 光学显微镜：局灶性或弥漫性的，各型肾小球肾炎。
? 临床表现：可出现全身(心、肝、脑、关节、皮肤等)多系统病变及各型肾炎综合征。
各型GN的演变关系
毛细血管内增生性GN
膜增生性GN
局灶性GN
系膜增生性GN
微小病变性GN
KEY WORD
? glomerulinephritis, Endocapillary proliferative GN, Membranous GN,? Mesangioproliferative GN, Membranoproliferative GN, Crescentic GN,? Minimal change GN, Focal GN, Sclerosing GN
三、急性肾小管坏死
( acute tubular necrosis )
由于休克或中毒导致的肾小管上皮细胞坏死，主要侵犯各段肾小管，主要临床表现为少尿、无尿和肾功能衰竭。
肾小球缺血
肾小球滤过率 肾小管上皮坏死 细胞碎片堵塞
尿液返流肾间质水肿
少尿或无尿
后期，再生的肾小管上皮功能不全 多尿和等比重尿
CONCLUSION
? Acute tubular necrosis: tubular epithelial cells show diffuse coagulation necrosis, caused by renal ischemia or poisoning, often occur acute renal failure.
? KEY WORD: Acute tubular necrosis
四、肾盂肾炎( pyelonephritis )
病原体感染直接引起的化脓性炎，主要侵
犯肾盂粘膜和肾间质，主要临床症状有急性感
染的全身症状、血尿、白细胞尿或脓尿、下尿
路刺激征。
? 急性肾盂肾炎：脓性卡它性炎；肾的蜂窝织炎；肾脓肿上行性感染者，近肾盂处严重，肾皮质轻,单肾发病或双肾分布不均血源性感染者，双肾弥散分布，以肾小球为中心形成小脓肿。
? 慢性肾盂肾炎；淋巴和单核细胞浸润；肉芽组织形成,结缔组织增生；厚壁脓肿；肾盂变形;瘢痕肾形成。
CONCLUSION
? Pyelonephritis: is a suppurative inflammation, is caused by infection of suppurative bacterium. The pelvis, interstitium and tubules is major injury site. Morphology:focal suppurative inflammation (phlegmonous inflammation or abscesses).Its clinical manifestations include: fever, malaise, flank pain, dysuria,frequency and urgency, pyuria and white cell casts.
五、过敏性间质性肾炎
( allergic interstitial nephritis )
概念：
各种过敏因素导致的非化脓性炎症，主要侵犯肾间质,主要的临床症状是肾功能损伤乃至肾功能衰竭。
病因发病机制：药物和其他过敏原导致IV型变态反应
CONCLUSION
? Allergic interstitial nephritis: is a nonsuppurative inflammation, is caused by drug allergy. The interstitium and tubules is major injury site. Morphology: mononuclear cells (lymphocytes and mono-phagocytes) and/or eosinocytes diffuse infiltrate in interstitium of both kidneys, so often occur acute renal failure.
? KEY WORD: Pyelonephritis,Allergic interstitial nephritis
六、肾脏肿瘤
(1) 肾细胞癌( renal cell carcinoma )
组织发生：近端肾小管上皮细胞
病理特点：位于肾皮质,切面黄色;富含透明胞浆的癌细胞呈巢索状排列。
生物性特性：中老年好发；因血管丰富，可早期血行转移至肺、骨。
CONCLUSION
? Renal cell carcinoma: Histogenesis: proximal tubular cells. Morphology: clear-cancerous cells and trabecularism. Clinical features: renal neoplasm and hematuria occur in 60th and 70th decades of men. Behavior: malignant tumor, often hematogenous metastasis.
(2) 肾母细胞瘤
( nephroblastoma, Wilm tumor )
组织发生:肾胚芽组织
病理特点:肾内巨大肉瘤样肿块;由未分化的胚芽组织、间胚叶性间质和幼稚的肾小球和肾小管组成
生物学特性:婴幼儿好发;早期血行转移至肺、肝等
CONCLUSION
? Nephroblastoma (Wilm's tumor):Histogenesis: renal blastem. Morphology: blastem tissue, abortive glomeruli and tubules, mesenchymal tissue. Clinical features: renal neoplasm and hematuria occur in 2-4 years childhood. Behavior: malignant tumor, often hematogenous metastasis.
七、尿路上皮肿瘤
组织发生:移行上皮细胞
病理特点:
移行上皮乳头状瘤:
与正常移行上皮相似的肿瘤组织呈乳
头状伸出性生长
CONCLUSION
? Urothelial tumors:Histogenesis: transitional cells. Morphology: papilloma and various grades carcinoma. Clinical features: hematuria occur in adult and old men. Behavior: benign papilloma easily recur and become malignant, transitional carcinoma which is often multi-focus growth, and progresisive infiltration, invasion and destruction of the surrounding tissue.
? KEY WORD: Renal cell carcinoma, Nephroblastoma, Urothelial tumors
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