lnlecturehebei ppt课件知识讲稿.pptx

狼疮性肾炎北京协和医院肾内科 李学旺2015年1月河北狼疮性肾炎概述Stichweh D,. Curr Opin Rheumatol 2004 16:577–587Bogdanovic R Pediatr Nephrol 2004 19:36–44Ortega LM, et al: Lupus (2010) 19, 557–574在未选择的病例大约有25%-50% 在SLE发病时就有临床肾脏疾病，病程中成人中的60% ，儿童中的 80% 的SLE患者会患狼疮性肾炎。 LN累计患病率:亚裔为55%、非裔51%、西班牙裔43%、高加索白人14%。非裔、西班亚裔和亚裔往往有更为严重的病例儿童易合并严重的肾炎，而老年人则较少。 International Society of Nephrology/ Renal Pathology Society (2003) Classification of Lupus Nephritis (LN) I Minimal mesangial LN II Mesangial proliferative LN III Focal LN* (50% of glomeruli) A A/C CIV Diffuse LN* (50% of glomeruli) Diffuse segmental (IV-S) or global (IV-G) LN A A/C CV Membranous LN, III+V IV+VVI Advanced sclerosing LN (90% globally sclerosed glomeruli without residual activity) Lupus nephritis class IILupus nephritis class II. There is mild global mesangial hypercellularity (periodic acid–Schiff, ×400). Lupus nephritis class II. Electron micrograph showing abundant mesangial electron-dense deposits (×12,000). Lupus nephritis class IIIThe glomerular endocapillary proliferation is discretely segmental with necrotizing features and an early cel- lular crescent (Jones methenamine silver, ×400). Lupus nephritis class III. There is focal segmental endocapillary proliferation (Jones methenamine silver, ×100). Lupus nephritis class IVLupus nephritis class IV. Electron micrograph show- ing a large subendothelial electron-dense deposit as well as a few small subepithelial deposits (arrow) (×1200). Lupus nephritis class IV. There is global endocapillary pro- liferation with infiltrating neutrophils and segmental wire loop deposits (hematoxylin and eosin, ×320). Lupus nephritis class VLupus nephritis class V. Silver stain highlights glomerular basement membrane spikes projecting outward from the glomerular base- ment membranes toward the urinary space (Jones methenamine silver, ×800). Lupus nephritis class V. Electron micro- graph showing numerous subepithelial electron-dense deposits as well as mesangial deposits (×5000). 其他病理学改变