泌尿系统疾病分析报告.pptx

泌尿系统疾病Ⅱ (Diseases of urinary system);Content;★ 1 急性弥漫性增生性肾小球肾炎 ★ 2 急进性(新月体性)肾小球肾炎 ★ 3 膜性肾小球病 ★ 4 微小病变性肾小球病 5 局灶性节段性肾小球硬化 6 膜增生性肾小球肾炎 7 系膜增生性肾小球肾炎 8 IgA肾病 ★ 9 慢性肾小球肾炎 ; 三、肾病综合征及相关的肾炎类型;Etiology of nephrotic syndrome;〔一〕膜性肾小球病 〔Membranous Glomerulopathy〕;Pathogenesis;;Pathological changes;Here is the light microscopic appearance of membranous glomerulopathy in which the capillary loops are thickened and prominent, but the cellularity is not increased. ;;A silver stain of the glomerulus highlights the proteinaceous basement membranes in black. There are characteristic spikes seen with membranous glomerulopathy seen here in which the black basement membrane material appears as projections around the capillary loops. ;;;Membranous glomerulopathy is an immunologically mediated disease in which deposts of mainly IgG and complement collect in the basement membrane and appear in a diffuse granular pattern by immunofluorescence.;〔二〕微小病变性肾小球病〔Minimal change glomerulopathy〕;Pathogenesis;Pathological changes;;;;两种肾病综合征相关性肾炎比较;五、慢性肾小球肾炎 (chronic glomerulonephritis);Pathogenesis;Pathological changes;A 大量肾小球玻璃样变及纤维化，所属的肾小管 也萎缩、纤维化、消失B 残留的肾单位代偿性肥大，肾小球体积增大， 肾小管扩张C 细小动脉玻璃样变及内膜增厚，管腔狭窄 D 间质纤维化，常伴有淋巴细胞及浆细胞浸润； “肾小球集中现象〞 ;;;早期有原发肾炎的病症 主要表现为Chronic nephritic syndrome Urinary changes：肾小球滤过率增加，肾小管重吸收减少→多尿、夜尿、低比重尿 Hypertension：肾小球硬化，肾单位缺血，肾素↑ Anemia：促红细胞生成素分泌减少 Azotemia or uremia：肾功衰竭，毒物蓄积;病程进展速度差异很大，但预后均极差，病人常死于尿毒症和高血压引起的心衰或脑出血;某青年妇女，近一周来发热，腰部疼痛剧烈，排浑浊尿液。查：急性热病容，双侧腰部压痛与扣击痛明显，余无明显异常。 1. 临床诊断？ 2. 如何解释这些病症、体症？;肾盂肾炎Pyelonephritis〔PN〕;Etiology;急性肾盂肾炎 Acute pyelonephritis;Infective pathway;上行性感染;Pathological changes; 灶状的间质化脓性炎或脓肿形成和肾小管坏死 Ascending infection 肾盂粘膜充血、水肿，炎细胞浸润 肾间质内 脓肿形成 肾小管内充满中性粒细胞，上皮细 胞变性坏死，很少累及肾小球 Hematogenous infection 先累及肾小球及周围的肾间质 肾盂;;This is an ascending bacterial infection leading to acute pyelonephritis. Numerous neutrophils are seen filling renal tubules across the center and right of this picture.;Acute pyelonephritis;Relationship bet