形態(tài)學(xué)：腎綜合

1、腎綜合 ANATOMY The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production DISEASES 腎炎 毛細(xì)血管內(nèi)增生性腎小球腎炎 新月體性腎小球腎炎 膜性腎炎 輕微病變性腎小球腎炎 局灶性/節(jié)段性腎小球腎炎或硬化 系膜增生性腎炎 膜性增生性腎炎 硬化性腎炎 IgA腎病 慢性腎小球腎炎 毛細(xì)血管內(nèi)增生性腎小球腎炎 新月體性腎小球

2、腎炎 新月體 iga 病因和發(fā)病機制 致病菌：腸道革蘭陰性菌 急性：一種，慢性：混合 感染途徑 1血源性感染 2上行性感染 繼發(fā)于下尿道感染 誘因 尿路阻塞 醫(yī)源性損傷 急性腎盂腎炎 腎盂和腎間質(zhì)的急性 化膿性炎癥 病理變化 肉眼 一側(cè)或兩側(cè)腎 稍大，充血，膿性滲出 物，膿腫，髓質(zhì)內(nèi)黃 色條紋 腎盂粘膜充血水腫 鏡下 累及腎間質(zhì) 急性化膿性炎癥 伴膿腫形成 腎盂粘膜充血水 腫，中性粒細(xì)胞 浸潤 腎小球不受損壞 臨床病理聯(lián)系 急性感染的全身表現(xiàn) 腰痛，腎區(qū)扣痛 膿尿，血尿 膀胱、尿道刺激癥狀 預(yù)后 治愈 腎乳頭壞死，腎盂積水，積膿 慢性腎盂腎炎 急性腎盂腎炎發(fā)展，起病隱匿 病理變化 特點：活動性

3、炎癥與修復(fù)、纖維化和瘢痕形成同時并存 肉眼 體積縮小，質(zhì)硬，外形不規(guī)則，瘢痕 切面：皮髓質(zhì)界限不清，腎盂腎盞變形 鏡下 腎間質(zhì)：炎癥細(xì)胞浸潤（淋巴細(xì)胞，漿細(xì)胞），纖維組織增生 腎小球：球囊壁纖維性增厚，同心圓性纖維化，玻變 腎小管：萎縮纖維化 代償性擴張，蛋白管型 臨床病理聯(lián)系 腎小管濃縮功能障礙 多尿，夜尿 低鈉，低鉀，代謝性酸中毒 結(jié)局 早期，控制 腎衰 腎細(xì)胞癌 來源于腎小管上皮 腎原發(fā)性腫瘤最常見 肉眼 分界清 多彩性 質(zhì)軟脆 Renal cell carcinoma The kidney is distorted by the tumor,located in the upper r

4、ole of the kidney. The tumor is very large ,about 7cm. On the cut surface we can say variegated due to hemorrhage,necrosis . The margin of the tumor looks clear,surrounding the tumor there is a peudocapsule. Renal pelvic carcinoma The tumor is papillary form,prejected into the pelvicalyceal, obstruc

5、ted the pelvis,caused the urine occumulated,and finally press the parenchyma of the kidney,formed the atrophy of the kidney. In clinic the patient may have hematuria and obstruction. Histologically most of renal pelvic carcinomas are belong to transitional cell carcinomas which is arise from the urothelium of renal pelvis. Carcinoma of bladder The tumor is papillary and project into the lumen. The tumor may occure anywhere,most commonly on the lateral walls,the next is the trigone. Histologically,the majority are transitional cell carcinomas,squam