繼發(fā)性腎小球腎炎課件

繼發(fā)性腎小球腎炎IgA腎病或腎小球腎炎病因發(fā)病機(jī)制：粘膜損傷→IgA形成→含IgA的大分子的免疫復(fù)合物沉積于腎小球病變特點(diǎn)：免疫病理：以IgA為主的免疫球蛋白和C3沉積于系膜區(qū)。光學(xué)顯微鏡：局灶性或彌漫性的，除膜性腎小球腎炎以外的各型腎小球腎炎。臨床表現(xiàn)：可出現(xiàn)血管炎和紫癜及各型腎炎綜合征。KEYWORDglomerulinephritis,EndocapillaryproliferativeGN,MembranousGN,MesangioproliferativeGN,MembranoproliferativeGN,CrescenticGN,MinimalchangeGN,FocalGN,SclerosingGN三、急性腎小管壞死

(acutetubularnecrosis)由于休克或中毒導(dǎo)致的腎小管上皮細(xì)胞壞死，主要侵犯各段腎小管，主要臨床表現(xiàn)為少尿、無尿和腎功能衰竭。概念:病因發(fā)病機(jī)制:休克，血壓降低，腎缺血，腎小管缺血性壞死；毒性物質(zhì)在腎小管濃縮，直接傷害腎小管上皮細(xì)胞。病理變化:

腎小管上皮凝固性壞死，細(xì)胞碎片堵塞管腔，腎間質(zhì)水腫；后期；腎小管上皮再生。四、腎盂腎炎(pyelonephritis)病原體感染直接引起的化膿性炎，主要侵犯腎盂粘膜和腎間質(zhì)，主要臨床癥狀有急性感染的全身癥狀、血尿、白細(xì)胞尿或膿尿、下尿路刺激征。

概念:病原體：大腸桿菌、鏈球菌、葡萄球菌、綠膿 桿菌、霉菌等感染途徑：上行性(大腸桿菌為主)；血源性(

少見,烈性化膿菌為主)誘發(fā)因素：下尿路梗阻;重病體弱,長(zhǎng)期臥床患者病因發(fā)病機(jī)制:CONCLUSIONPyelonephritis:isasuppurativeinflammation,iscausedbyinfectionofsuppurativebacterium.Thepelvis,interstitiumandtubulesismajorinjurysite.Morphology:focalsuppurativeinflammation(phlegmonousinflammationorabscesses).Itsclinicalmanifestationsinclude:fever,malaise,flankpain,dysuria,frequencyandurgency,pyuriaandwhitecellcasts.五、過敏性間質(zhì)性腎炎

(allergicinterstitialnephritis)概念：各種過敏因素導(dǎo)致的非化膿性炎癥，主要侵犯腎間質(zhì),主要的臨床癥狀是腎功能損傷乃至腎功能衰竭。病因發(fā)病機(jī)制：藥物和其他過敏原導(dǎo)致IV型變態(tài)反應(yīng)病理變化：

急性過敏性間質(zhì)性腎炎:雙腎腎間質(zhì)彌漫性水腫，淋巴、單核及多少不等的嗜酸性白細(xì)胞浸潤(rùn)，腎小管上皮細(xì)胞變性

慢性過敏性間質(zhì)性腎炎:雙腎腎間質(zhì)淋巴和單核細(xì)胞浸潤(rùn)，纖維化，腎小管彌漫萎縮。臨床病理聯(lián)系：腎間質(zhì)彌漫性病變導(dǎo)致腎小管彌漫性損傷，嚴(yán)重?fù)p傷腎功能。CONCLUSIONAllergicinterstitialnephritis:isanonsuppurativeinflammation,iscausedbydrugallergy.Theinterstitiumandtubulesismajorinjurysite.Morphology:mononuclearcells(lymphocytesandmono-phagocytes)and/oreosinocytesdiffuseinfiltrateininterstitiumofbothkidneys,sooftenoccuracuterenalfailure.KEYWORD:Pyelonephritis,Allergicinterstitialnephritis六、腎臟腫瘤(1)腎細(xì)胞癌(renalcellcarcinoma)組織發(fā)生：近端腎小管上皮細(xì)胞病理特點(diǎn)：位于腎皮質(zhì),切面黃色;富含透明胞漿的癌細(xì)胞呈巢索狀排列。生物性特性：中老年好發(fā)；因血管豐富，可早期血行轉(zhuǎn)移至肺、骨。CONCLUSIONRenalcellcarcinoma:Histogenesis:proximaltubularcells.Morphology:clear-cancerouscellsandtrabecularism.Clinicalfeatures:renalneoplasmandhematuriaoccurin60thand70thdecadesofmen.Behavior:malignanttumor,oftenhematogenousmetastasis.(2)腎母細(xì)胞瘤

(nephroblastoma,Wilmtumor)組織發(fā)生:腎胚芽組織病理特點(diǎn):腎內(nèi)巨大肉瘤樣腫塊;由未分化的胚芽組織、間胚葉性間質(zhì)和幼稚的腎小球和腎小管組成生物學(xué)特性:嬰幼兒好發(fā);早期血行轉(zhuǎn)移至肺、肝等CONCLUSIONNephroblastoma(Wilm’stumor):Histogenesis:renalblastem.Morphology:blastemtissue,abortiveglomeruliandtubules,mesenchymaltissue.Clinicalfeatures:renalneoplasmandhematuriaoccurin2-4yearschildhood.Behavior:malignanttumor,oftenhematogenousmetastasis.七、尿路上皮腫瘤組織發(fā)生:移行上皮細(xì)胞病理特點(diǎn):

移行上皮乳頭狀瘤:

與正常移行上皮相似的腫瘤組織呈乳頭狀伸出性生長(zhǎng)移行上皮癌:

有一定異型性的癌組織呈伸出性 和浸潤(rùn)性生長(zhǎng)；依癌組織的異 型性，分為I、II、III級(jí)生物學(xué)特性:

中老年好發(fā);易復(fù)發(fā)；以局部浸 潤(rùn)和淋巴路轉(zhuǎn)移常見CONCLUSIONUrothelialtumors:Histogenesis:transitionalcells.Morphology:papillomaandvariousgradescarcinoma.Clinicalfeatures:hematuriaoccurinadultandoldmen.Behavior:benignpapillomaeasilyrecurandbecomemalignant,transitionalcarcinomawhichisoftenmult