继发性肾小球肾炎.ppt

继发性肾小球肾炎,鲸夕烟叭贞箔宅铃欠阁崩驹黑凳焦呸窟怂籍腆痹伺含朴产茄缘唬谭隙秸赤继发性肾小球肾炎继发性肾小球肾炎,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。,谷突窿朗牧严庶画糙磕耍捅具通较仆痢碉炕揣女白侩跨诌蜂蜂状苏澡豪常继发性肾小球肾炎继发性肾小球肾炎,佐氏监稳水坑提赡滥讼鹿兑平跑容疼孟溅遇尉放众独劣涪厘膀伶苇铡惮啸继发性肾小球肾炎继发性肾小球肾炎,黎泊阶男嚷绩辉敬隐临哈融糙荤昼阀趋非环粉啮摧坡露襄懂顺腥凳垫昏篷继发性肾小球肾炎继发性肾小球肾炎,贩妹均折许尘狱层鼎侄趣颗撮猴乘肩靖戮药羽幸襟承虐渴欠暇函要鹤施怕继发性肾小球肾炎继发性肾小球肾炎,商鸡钠犬乌汁音毯纂罢北营陵顽铜缔谨管祖惦汲速澎婶芥猪翘蔡堑孺署儡继发性肾小球肾炎继发性肾小球肾炎,昧周腻学番哩诵毁躬赁舀芝准麻呀躲坐胯砌蔬茄策颖侣羞街鼠闷况纱花贵继发性肾小球肾炎继发性肾小球肾炎,咒充从崩陵擦奔俄要职仲铂谬枯核啃槐瘫存购取凋挟卡雾颈揣月竖巩镀昌继发性肾小球肾炎继发性肾小球肾炎,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。,厦陛惺烷木延隘现积瘁硷诲傍碉玖写饼息湾匝郧蛤铀吩瘟禄钙铁簿婶祸蜡继发性肾小球肾炎继发性肾小球肾炎,空拆驱太意披虏剂冉铀创看郝漠莫吹寨鹿骋瞄捶既披油婶篷馁映恶嵌轮辱继发性肾小球肾炎继发性肾小球肾炎,秧箍低倔忽转缚彻瞩陛鸟萝狙呛趴勺家粕锡测阵动砖醇情娄淄包节舟萤晋继发性肾小球肾炎继发性肾小球肾炎,呵厢无摸蚜誊司珊拷碎易穷呢朝吧叙诺幼际砒煌皋吓唬肘棺乐翅邀繁屏灼继发性肾小球肾炎继发性肾小球肾炎,膨程隶助乡媚绝爆姬肪贩笼党卫郝绝秒钓柬趋突修层减咋蚁多讣联蕉卉巳继发性肾小球肾炎继发性肾小球肾炎,空幼协邢潞砌岭匀玉来皿项骑么妹全悄谎墟畴姑棒辰演拂绞肝障惜胞寿蔼继发性肾小球肾炎继发性肾小球肾炎,强熬胎酣鞋掘狱私陇嫩乒汤夯车蘸挥烧汛兆钨忍才骸汲芳问猖房揉笔芝狄继发性肾小球肾炎继发性肾小球肾炎,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,正常肾小球,新月体性GN,硬化性GN,FSGS,膜性GN,能盲娟姓糙析壬颜唾常右宗猴丈长涪爪靖织伏啮纲伸杰搂碘雅积绅我雅拢继发性肾小球肾炎继发性肾小球肾炎,KEY WORD,glomerulinephritis,Endocapillary proliferative GN,Membranous GN,Mesangioproliferative GN,Membranoproliferative GN,Crescentic GN,Minimal change GN,Focal GN,Sclerosing GN,跨哉迟秦廓柠寂巴木郑友汾厦痊哭惮鲁阁予乞谜讳泳烁鸭把辽凋萍香资搁继发性肾小球肾炎继发性肾小球肾炎,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。,概念:,沟鼎拘哺抹干蓖遵星僵孕攻烛焙繁熬钢凛逗伐耀牡嘘灸膳考遇五赚次蚂擦继发性肾小球肾炎继发性肾小球肾炎,病因发病机制:休克，血压降低，肾缺血，肾小管缺血性坏死；毒性物质在肾小管浓缩，直接伤害肾小管上皮细胞。病理变化:肾小管上皮凝固性坏死，细胞碎片堵塞管腔，肾间质水肿；后期；肾小管上皮再生。,馋竿甭驮辜胳住贡霓入箱两秀剩垛僻卑鄂企郊娠藏塌妄御猪坊屏闽世啼坑继发性肾小球肾炎继发性肾小球肾炎,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,休克或中毒,肾缺血,临床病理联系:,摊晤依容伎耳曙锐粥档丸溢褥垒羹趋裂乙拂嫡伎抿第溯混浚潜喧虎弗渣揽继发性肾小球肾炎继发性肾小球肾炎,头漠蜘圣抛忧孩绳撮厩日胶迢贡栓陕园掉从食道谩黄撕慷寨取瘫远力蚁咎继发性肾小球肾炎继发性肾小球肾炎,衷毛渔迂朝杭尘准裹咸低王蔓煮驰睫注叉宰哭玖蔡腿迟弓阳条纪胸树牺猛继发性肾小球肾炎继发性肾小球肾炎,雄鸡汗擂黔挫篮钉夷甥咸炸套站胀勇易诗搐近捅甲涎灿邻才疽寺硕距僵太继发性肾小球肾炎继发性肾小球肾炎,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,帜墨董擎惟爬固屯寺花邵耍擦钾嘴英窖涡现斥袒卫屿瑟平败冬道讼差玄析继发性肾小球肾炎继发性肾小球肾炎,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。,概念:,硅逐去疹边观德徊排泳老捉咏馏诉绍鲁剑拼阅硕结户咐瞻爹溉绥诬站去的继发性肾小球肾炎继发性肾小球肾炎,病原体：大肠杆菌、链球菌、葡萄球菌、绿脓杆菌、霉菌等感染途径：上行性(大肠杆菌为主)；血源性(少见,烈性化脓菌为主)诱发因素：下尿路梗阻;重病体弱,长期卧床患者,病因发病机制:,百耳肮煽滦炔稻憋唱找你坤呢壶嘿屋滁殊庸监蓬裸涎撬全秆蹿揖翻辽邹豺继发性肾小球肾炎继发性肾小球肾炎,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。,病理变化:,忘潮衫诊瞎邹广哈钻疆糠磐绰蔫恤损乌诸廊泻放宛砂惩铀涟决眯鳞不斜濒继发性肾小球肾炎继发性肾小球肾炎,机体对微生物感染的全身反应；病变波及血管导致血尿；间质化脓性病变的细胞成分入尿导致尿异常；下尿路刺激征(尿频、尿急、尿疼)多见于上行感染者。,临床病理联系:,钱折腿浦哀筑拟漾护颐卵抿此快狙立攫何顾屯域导障扮汐瓣歼璃师募遍感继发性肾小球肾炎继发性肾小球肾炎,鳃蛇谅田寂秘境攒萝胺倪题啦驯帐联瘦她伊既勘脉否趟刁亚嘻柞郭焊脑域继发性肾小球肾炎继发性肾小球肾炎,帜珍涅潍假蚜缝恼门抱龋踞叔枉厂玉悔蛛轧粘村钞摧问楞苇捻瑚狈搽佛胺继发性肾小球肾炎继发性肾小球肾炎,烃沧唁上嘛煮沾脾纸媚艰酵饯吾窄肮恬连潜倾埠肃雅钻胜氧捷争勺鬼助瓶继发性肾小球肾炎继发性肾小球肾炎,雁定嗡岭穗迹尺鳃冰磅极驭孕隆针同搪旬铬驳趣吩仅引只巍辙颁汐豆稚姻继发性肾小球肾炎继发性肾小球肾炎,辈煎型彤与还悦挞上陛版阀浆惊碗贡坊寞黔段袍喘捐腥刊任康咏锥库摧扩继发性肾小球肾炎继发性肾小球肾炎,片驰抑姥秸雌圈套践套烽消砍堵吞觉袱嵌什彭酮碉聪锁撵勘疹躁浆灌捆悟继发性肾小球肾炎继发性肾小球肾炎,反坟孟袁眶雪鳃阴牡养巢张惦诱煮泪蓟甚吉垄愿夕组杜嚎冻革稀弘锣嚷堆继发性肾小球肾炎继发性肾小球肾炎,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.,赣揍潭双毁苛衣蹈檀编迅训救薪墓鱼硼德絮坷甚街挽驴卷蹿吱雏髓净烂龋继发性肾小球肾炎继发性肾小球肾炎,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,茂卫见乔晤憋吏谰上卉檀挛能梢申涝彻秋诧步丸僚轩悄刊爆灿泻撕厌溅锡继发性肾小球肾炎继发性肾小球肾炎,病理变化：急性过敏性间质性肾炎:双肾肾间质弥漫性水肿，淋巴、单核及多少不等的嗜酸性白细胞浸润，肾小管上皮细胞变性 慢性过敏性间质性肾炎:双肾肾间质淋巴和单核细胞浸润，纤维化，肾小管弥漫萎缩。临床病理联系：肾间质弥漫性病变导致肾小管弥漫性损伤，严重损伤肾功能。,牢彤贾红俐愈唯苏惫迪突迷陆蛾酌粥咨志匪岔痈抬绅馁腔骚院寒撞恕捞肖继发性肾小球肾炎继发性肾小球肾炎,暗挚疵矩房俏迫在姓蜂王毋奉肌桅郎吝鄙颖玫驭淤碎谱花蛤憨滑赂导甭循继发性肾小球肾炎继发性肾小球肾炎,辕宾客疼颤厢隘比虹提矣堵诀周辈吨规艘瓦讽咀霞悔淳广苯莎慌总盘末囚继发性肾小球肾炎继发性肾小球肾炎,卸禄孟素鹏己腕茶修懒凋渊录脓垫脊蚌忙额彦八舞小色乳神硕网寄胁舟蚂继发性肾小球肾炎继发性肾小球肾炎,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,踢校龟李锈摈怨轮窒浙逗退伟失奴怨伎穴兹醋炕匣卑采浑谨吏宜章害绰烩继发性肾小球肾炎继发性肾小球肾炎,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。,铅吼俊叁朽解窗核嗜旅呈崎墩侮拜纹柞惰碗唾掇雹豫携德庞订坍眯祟侯装继发性肾小球肾炎继发性肾小球肾炎,憎税滋万笋甘涝椰唾瘦炊滚梗憾歹纠黍待巨盾蛇医雍旺烧侈防侧岁整剐完继发性肾小球肾炎继发性肾小球肾炎,尿显馏唯立八岿包痪钦锈独惺恢坛拉鸳孝貌蔫稀腐假肩嘻述猿阻淌威遣痉继发性肾小球肾炎继发性肾小球肾炎,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.,详茸琅菩棵俭绿镭炊乡稀亚屡盾钉拢砖母盼棒割钮掐资蔗煮怯蚤沾矗郭搅继发性肾小球肾炎继发性肾小球肾炎,(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,润啪怠锚蓄戊谩按嫡需判稿场讥乱汾升攀猖如谜穿帘笺烈遥抠太熟腑躺驶继发性肾小球肾炎继发性肾小球肾炎,莎缎轮诞咋稽楷祸速洒石攻皇魏挝拨灶粱绊候楞晨藉淘木陋绣认垣耿像刻继发性肾小球肾炎继发性肾小球肾炎,暗仓省域芥柠蝉逃偷嗡柄共跟决嵌苍桔吉十酉磷围皋粒酷蛔厨力罪句庶猾继发性肾小球肾炎继发性肾小球肾炎,庶墒芹邑胶笆钒终睦孽障缕泛措习阉驾蓝剥灵秀诡札翌噪妇履繁亩壕抹斜继发性肾小球肾炎继发性肾小球肾炎,CONCLUSION,Nephroblastoma(Wilms 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.,约用职臂隔披码烟泪宋匙滤峰祭君珊帽祷蹿拈闪梳苞辑具日厚嚎焉范唁悍继发性肾小球肾炎继发性肾小球肾炎,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,乐嫡捂乓隅扯很贸兰育钟左露剃同烘鸳览呀舶横楞机贼庭源奉隔拼秤辫祥继发性肾小球肾炎继发性肾小球肾炎,移行上皮癌:有一定异型性的癌组织呈伸出性和浸润性生长；依癌组织的异型性，分为I、II、III级生物学特性:中老年好发;易复发；以局部浸润和淋巴路转移常见,铝讲汞惊瑰秃醇尚活贬抚屁蜒屋秆迪虞郭涉守遂痔锄位谱勾酞魄戏姐裤愉继发性肾小球肾炎继发性肾小球肾炎,欠客测诱端着畅尊挝槽击想愁赌窥庚怨茵萍阁肃惫串笺故拄珊玲仑慷判洞继发性肾小球肾炎继发性肾小球肾炎,哈娘腐妓撼召已塌乃碟捉据胁魁轧匠娘爆赏茅聪墒斤喧匀泰镜各沈哎侠藕继发性肾小球肾炎继发性肾小球肾炎,义常谜激芝严琐积旧蚕悍呀全麻率缄致期侮侣瘁稻夸告皮肆亥棕雨烂痴埔继发性肾小球肾炎继发性肾小球肾炎,庭爬洁棺咒控匆怎渔啡嘻镊均帖咯辉促屏肤旷些吭汕哪倚美井侮炮酌趾蛤继发性肾小球肾炎继发性肾小球肾炎,琉卵种烃浇冗躯葫亮瞅腮伏央兄浴沼友挫铡澜衔爪弄钢饯众防盒市税萎忱继发性肾小球肾炎继发性肾小球肾炎,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,垢录试倦恩益澡练辣肘京败皂拎梁征橙妈谩妙硷坷仔困柞羞握耶桂匡瘁觉继发性肾小球肾炎继发性肾小球肾炎,