临床医学丁小强肾小球疾病ppt课件.ppt

肾小球疾病;Pathological changes -- glomerular injury Clinical manifestations --proteinuria / hematuria; primary glomerular diseases secondary glomerular diseases hereditary glomerular diseases; ;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 ;Why does CIC deposit in the glomeruli?; (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; B. Cell-mediated immune mechanisms minimal change glomerulopathy ? ;C. Non –immune mechanisms glomerular hypertension hyperlipidemia (LDL- Cho) advanced glycosylation end products (protein) glomerulosclerosis ;Inflammation; Mediators of inflammation   - active oxygen and active nitrogen - lipids - complements - cytokines - chemotatic factors  - adhesion molecules  - growth factors - vasoactive substances;To arouse or promote - proliferation of cells - accumulation of extracellular matrix - changes of histological structure - expression of immunomodulating molecules and adhension molecules ; Mechan