内科学肾病综合征(英文).ppt

Figure 7a. Early MN: a glomerulus from a patient with severe nephrotic syndrome and early MN, exhibiting normal architecture and peripheral capillary basement membranes of normal thickness (Silver–methenamine ×400). Figure 7b morphologically advanced MN Figure 7c. Morphologically more advanced MN (same patient as in (b)) Membranous nephropathy(MN) Clinical manifestations: 80% with NS 30% with microscopic hematuria Renal vein thrombosis seen in 40-50% patients Focal segmental glomerulosclerosis (FsGs) Epidemiology Over the past two decades, there has been an increased incidence of FSGS, accounting for 10% in our country. Some cases developed from MCD. Focal segmental glomerulosclerosis (FsGs) Pathology It is characterized by focal and segmental glomerular sclerosis Nonsclerotic glomeruli and segments usually have no staining for immunoglobulins or complement. Figure 6. Light microscopic appearances in focal segmental glomerulosclerosis. Segmental scars with capsular adhesions in otherwise normal glomeruli. Focal segmental glomerulosclerosis (FsGs) Clinical manifestations: NS ? with hematuria Hypertension and renal function declining are common Mr. O Minimal change disease (MCD) Mesangial proliferative glomerulonephritis (MsPGN) Membranoproliferative glomerulonephritis (MPGN) Membranous nephropathy (MN) Focal segmental glomerulosclerosis (FsGs) Mr. O Minimal change disease (MCD) Mesangial proliferative glomerulonephritis (MsPGN) Membranoproliferative glomerulonephritis (MPGN) Membranous nephropathy (MN) Focal segmental glomerulosclerosis (FsGs) Complications Infection malnutrition loss of immunoglobulins corticosteroids Thrombosis coagulation, corticosteroids, PLT activity Complications Acute renal failure (ARF) Hypoalbuminemia Hypovolemia pre-renal azotemia Protein malnutrition and dyslipidemia Diagnosis Diagnosis: NS ? Primary or secondary ? Patholog