肾脏活体组织病理检查的诊断意义课件PPT.ppt

膜增生性肾炎Ⅰ型 膜增生性肾炎Ⅰ型 膜增生性肾炎Ⅰ型 Moving from urinary space to capillary limen there is the urinary space, effaced foot processes, the lamina lucida externa, lamina densa, the subendothelial electron dense deposits which are lying adjacent to the little fingers of mesangial cytoplasm that have extended into the subendothelial zone, new basement membrane material, and endothelial cell with pores. 膜增生性肾炎Ⅰ型 This electron micrograph shows the urinary space, the effaced foot processes, the original basement membrane, and conspicuous subendothelial deposits. 膜增生性肾炎Ⅰ型 Immunofluorescence microscopy (slide 47) typically demonstrates peripheral granular or band-like staining that may outline the hypersegmentation. In many patients with type I MPGN, C3 will be the most conspicuous component in the deposits, especially in the idiopathic childhood variant. Patients with MPGN often have hypocomplementemia and a circulating autoantibody called C3 nephritic factor, which binds to the C3 convertase of the alternative pathway. 膜增生性肾炎Ⅰ型 Hepatitis C infection is a common cause for type I membranoproliferative glomerulonephritis, especially if it is accompanied by mixed cryoglobulinemia. When mixed cryoglobulinemia is present, sometimes as shown in, there will be globular accumulations of cryoglobulin in the capillary lumens. These can be seen by light microscopy as hyaline thrombi. 膜增生性肾炎Ⅰ型 Sometimes, when the immune complexes are derived from cryoglobulins, there will be tubular arrays in the deposits that have about a 30-40 nanometer diameter. When these immunotactoids are present in the absence of cryoglobulinemia, the appropriate diagnostic term is immunotactoid glomerulopathy 膜增生性肾炎Ⅰ型 This is an uncommon disease that is sometimes accompanied by a B-cell neoplasms. Immunotactoid glomerulopathy should not be confused with the more common disease called fibrillary glomerulonephritis, which is characterized ultrastructurally by approximately 20 nm diameter fibrils 膜增生性肾炎II型 膜增生性肾炎II型