新英格兰双语病例讨论2.ppt

③滤过膜 filtration membrane 又称滤过屏障 filtration barrier，由有 孔毛细血管内皮、基膜和足细胞裂孔膜构成。 滤过屏障模式图 返回 diffusely thickened capillarywalls and mild endocapillary proliferation Cellular crescents (arrows) tubular atrophy and interstitial inflammation fragmented red cells The GBM was markedly thickened, imparting a “wire loop” appearance 白金耳 abundant granular immune-complex deposition in the mesangium and along the glomerular basement membrane in a classic “full house” pattern 满堂亮 (anti-IgG immunofluorescence) Immunecomplex deposition is also seen along the tubular basement membrane abundant electron-dense deposits are seen in a mesangial, intramembranous, subepithelial, and subendothelial distribution showed strong staining with IgG, IgM, IgA, C3, C1q, and kappa and lambda light chains in a granular pattern in the mesangium and along the GBM 所涉及的病理学术语的定义 弥漫性病变(diffuse)：病变累及50％肾小球。 局灶性病变(focal)：病变仅累及≤50％肾小球。 球性病变(global)：病变累及一个肾小球的大部分毛细血管袢(50％)。 节段性病变(segmental)：病变仅累及一个肾小球的少部分毛细血管袢(≤50％)。 系膜细胞增生(mesangial hypercellularity)：3μm切片中，一个系膜区超过3个细胞。 毛细血管内增生(endocapillary proliferation)：肾小球毛细血管内皮细胞和系膜细胞增生，单个核细胞浸润，导致毛细血管腔狭窄。 * * Bilingual case discussion 2015-09-11 A 35-year-old man with dyspnea, anemia, and renal failure several weeks ago,the patient felt fatigue . Two days before admission, dyspnea developed , decreased urination,without fever, cough, or chest pain,no hemoptysis咯血,chills, night sweats, headaches, visual loss, dry eyes,dry mouth, or joint pain. He was transferred by ambulance to the emergency department at this hospital Four years before admission, he had been evaluated because of back pain, fatigue, and a temperature of 38.6°C.Urinalysis showed hematuria血尿 and proteinuria；testing for rapid plasma reagin(RPR快速血浆反应素) was positive for antibodies to Treponema pallidum（梅毒螺旋体）. During the previous 6 months, the patient had had episodes of bilateral finger, ankle, and facial swelling, without pain or change in color.