快速进展性IgA肾病.pptVIP

IgAN-MHT was not associated with the background glomerular pathological phenotypes of IgAN 45 patients with IgAN-MHT, 7 (15.56%), 5 (11.11%), 13 (28.89%), 9 (20%) and 11 (24.44%) patients were graded as Hass I, II, III, IV and V severity of non-ischaemic sclerosis, crescents and mesangial proliferation were significantly different between patients with different grades Blood pressure, SCr and proteinuria at presentation were comparable Nephrol Dial Transplant (2008) 23: 3921–3927 Renal and patient survival in malignant hypertension secondary to IgA nephropathy (IgANMHT) patients and primary malignant hypertension (PMHT) patients Kidney Blood Press Res 2005;28:251–258 IgA肾病合并TMA IgA肾病常常合并肾内小动脉或者细小动脉病变，表现为管壁增厚和玻璃样变。 合并TMA的IgA肾病71%存在难以控制的高血压，其中26%为恶性高血压。 肾脏组织中，硬化的肾小球与明显的肾小管间质病变。 Thrombotic microangiopathy (TMA) A heterogeneous disorder characterized by platelet thrombi in arterioles and. Renal histopathologic lesions in TMA tend to take one of two broad forms with considerable overlap: (1) predominant arteriolar, and lesser arterial, involvement, with thrombi and fibrinoid necrosis, particularly in TTP, malignant hypertension (MHT), and scleroderma; (2) glomerular involvement, with capillary thrombi, capillary loops with double contours due to mesangial interposition, and variable mesangiolysis, the latter most frequently seen in the HUS. Histologic Findings in Patients with IgAN-Associated TMA Acute TMA in artery. Fresh TMA in segment of interlobular artery (arrow, upper right). Adjacent section shows marked intimal fibroplasias and mild medial hypertrophy. Patient with malignant hypertension. Organizing TMA in afferent arteriole. Residual red staining fibrinoid material, with portion of foam cell visible. Internal elastica is maximally stretched. Glomerulus and parenchyma largely intact. Patient ormotensive, without antihypertensive agents. J Am Soc Nephrol 23, 2012. doi: 10.1681/ASN.2010111130 Significance of differences in survival betweengroups J Am Soc N