病理学第九章泌尿系统疾病.ppt

* Depending on the underlying causes, the glomeruli may show focal necrosis and the proleferation of ……. * Regardless of type, electron microscopy may show distinct ruptures in the GBM * In time, most crescents undergo sclerosis. If patients got early aggressive treatment, restoration of normal glomerular architecture may be achieved. However, some patients may eventually require chronic dialysis or transplantation 硫酸肝素 粘多糖;? 葡萄胺聚糖 * Why? Antigen-antibody reactions * Several factors affect glomerular localization of antigen, antibody, or complexes of both. The molecular charge and size of these reactants are clearly important. Highly cationic immunogens tend to cross the GBM, and the resultant complexes eventually reside in a subepithelial location. Highly anionic macromolecules are excluded from the GBM and either are trapped subendothelially or are not nephritogenic at all. Molecules of neutral charge and immune complexes containing these molecules tend to accumulate in the mesangium. Large circulating complexes are not usually nephritogenic, because they are cleared by the mononuclear phagocyte system and do not enter the GBM in sufficient quantities. The pattern of localization is also affected by changes in glomerular hemodynamics, mesangial function, and integrity of the charge-selective barrier in the glomerulus. These influences may underlie the variable pattern of immune reactant deposition in various forms of glomerulonephritis. In turn, the distinct patterns of localization of immune complexes is a key determinant of the injury response and the histologic features that subsequently develop * Antibodies may also react in situ with previously “planted” nonglomerular antigens. These planted antigens may localized in the kidney by interacting with various intrinsic components of the glomerulus. Planted antigens include DNA (in SLE), which has an affinity for GBM components; bacterial products, such as endostreptosin, a protein of group A streptococc