复旦大学临床医学专业：《内科学》课程教学资源（PPT课件讲稿）肾小球疾病（丁小强）

肾小球疾病 Glomerular diseases 丁小强 复旦大学附属中山医院

肾小球疾病 Glomerular Diseases 丁小强 复旦大学附属中山医院

a group of diseases Patho logical changes glomerular InJury Clinical man i festations --prote inur ia/hematur ia Comp/icated causes mechanisms Var ious clinical manifestations Different prognosis Multiple treatment

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

• primary glomerular diseases • secondary glomerular diseases • hereditary glomerular diseases

Immune mechanismsNon-immune Humoral Cell-mediated mechanisms Inflammation Glomerular diseases

Immune mechanisms Humoral Cell-mediated Non-immune mechanisms Inflammation Glomerular diseases

A。 Immune mechanisms (A) deposits of Circulating Immuno-Complex CIC) circlation antigen+ antibody CIC kidney CIC/deposits

A. Immune mechanisms (A)deposits of Circulating Immuno-Complex (CIC) circilation antigen+ antibody CIC kidney CIC/deposits

antigen extrinsic drugs--nonhomologous serum, penicillin foods--xenogenic protein pathogen-specific serotypes streptococci, HBV.HCV intrinsic nucleus (SLE) cytoplasm (ANCA) cellular membrane antigen of tumor antigen of thyroid

antigen extrinsic drugs--nonhomologous serum, penicillin foods—xenogenic protein pathogen—specific serotypes streptococci, 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 glomerular capillaries more chances to contact Net structure of cic easy to deposit and settle down Clearance dysfunction of mesangial cells disability of mononuclear macrophage, component or function defect of complements Decrease clearance of cic

Why does CIC deposit in the glomeruli? • Large area of glomerrular capillaries --more chances to contact • Net structure of CIC --easy to deposit and settle down • Clearance dysfunction of mesangial cells, disability of mononuclear macrophage, component or function defect of complements Decrease clearance of CIC

(B)in situ Immunocomplex Native renal antigen glomerular basement membrane anti-glomerular basement membrane antibod (anti-glomerular basement membrane glomerulonephritis) 2. Antigens trapped or planted DNA+ anti-DNA antibody Lupus Nephritis)

(B)in situ Immunocomplex 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 macrophage component or function defect of complements IC deposit clearance

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 macrophage • component or function defect of complements IC deposit > clearance

B. Cell-mediated immune mechanisms minimal change glomerulopathy

B. Cell-mediated immune mechanisms minimal change glomerulopathy ?