文档介绍：肾小球疾病
Glomerular Diseases
丁小强
复旦大学附属中山医院
Pathological changes
-- glomerular injury
Clinical manifestations
--proteinuria / hematuria
A group of diseases
Complicated causes & mechanisms
Various clinical manifestations
Different prognosis
Multiple treatment
primary glomerular diseases
secondary glomerular diseases
hereditary glomerular diseases
Immune mechanisms
Humoral
Cell-mediated
Non-immune
mechanisms
Inflammation
Glomerular diseases
A. Immune mechanisms
(A)deposits of Circulating plex (CIC)
circilation antigen+ antibody
CIC
kidney CIC/deposits
antigen
extrinsic
drugs--nonhomologous serum, penicillin
foods—xenogenic protein
pathogen—specific serotypes i, HBV, HCV
intrinsic
nucleus(SLE)
cytoplasm(ANCA)
cellular membrane
antigen of tumor
antigen of thyroid
Why does CIC deposit in the glomeruli?
Large area of glomerrular capillaries --more chances to structure of CIC --easy to deposit and settle down
Clearance dysfunction of mesangial cells, disability of mononuclear macrophage, component or function defect plements
Decrease clearance of CIC
(B)in situ plex
1. Native renal antigen
glomerular basement membrane
+ anti- glomerular basement membrane antibody
(anti- glomerular basement membrane glomerulonephritis)
2. Antigens trapped or planted
DNA+ anti-DNA antibody
(Lupus Nephritis)
Balance between the deposit and clearance of IC determines the situation of the diseases
Persistence of antigen
Clearance dysfunction of mesangial cells
disability of mononuclear ponent or function defect plements
IC deposit > clearance
B. Cell-mediated immune mechanisms
minimal change glomerulopathy ?