《继发性肾小球肾炎》PPT课件.ppt
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,正常肾小球,新月体性GN,硬化性GN,FSGS,膜性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。,概念:,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。,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:,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。,概念:,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:,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:,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:,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,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。,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(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.,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,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,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,
