病理学泌尿系统.pptVIP

This is IgA nephropathy (Berger disease). The IgA is deposited mainly within the mesangium, which then increases mesangial cellularity as shown at the arrow. Patients with IgA nephropathy usually present with hematuria. Histologically, the lesions in IgA nephropathy vary considerably. The glomeruli may be normal or may show mesangial widening and segmental inflammation confined to some glomeruli (focal proliferative GN); diffuse mesangial proliferation (mesangioproliferative); or (rarely) overt crescentic GN. Electron-dense deposits in the mesangium under GBM The characteristic immunofluorescence picture is of mesangial deposition of IgA, often with C3 and properdin and smaller amounts of IgG or IgM (Fig. 14-11). Early components of the classical complement pathway are usually absent. Electron microscopy confirms the presence of electron-dense deposits in the mesangium. The deposits may extend to the subendothelial area of adjacent capillary walls in a minority of cases, usually those with focal proliferation IgA肾病肾病是世界范围内一种常见的肾小球疾病，IgA肾病的流行在不同洲、不同国家或在一个国家不同地区的差异很大，如亚洲的日本、新加坡，IgA肾病肾病的发病率占原发性肾小球疾病的50％，而美国西部的印第安人低发区只占2％。一般而言，白人、黄种人明显高于黑人的发病率。我国IgA肾病的发病率占原发性肾小球疾病的26％￣34％。男女之比大约是2:1。 以血尿为主的IgA肾病目前尚无特效的治疗。由于IgA肾病的病理类型及肾小球受损程度的差异较大。因此，应严密观察患者肉眼血尿发作的频率、蛋白尿的程度、有无高血压及肾功能受损程度，而分别采取相应的防治措施。 The disease most often affects children and young adults. More than half of those with IgA nephropathy present with gross hematuria after an infection of the respiratory or, less commonly, gastrointestinal or urinary tract; 30% to 40% have only microscopic hematuria, with or without proteinuria; and 5% to 10% develop a typical acute nephritic syndrome. The hematuria typically lasts for several days and then subsides, only to return every few months. Age,broteinurin,HP A major cause of chronic renal failure in adults. An end-stage pool of glomerular diseases. (Remember, chronic inflammation is a time-honored misnomer for severe, irreversible scarring.) Given the usual trans-stygian kidne