内科主治医师专业知识：肾小球疾病分类与机制概述.pdfVIP

glomerular

disease

一、概述

Testpoints:Themechanismsofimmuneinfltionandnon-immuneinfltion(understand)

Theclinicalmanifestationsarethesamebuttheetiological

mechanismsaredifferent.Mostglomerulonephritisisan

immune-mediatedinfltorydisease.Testpoints:

Clinicopathologicalclassificationofprimaryglomerulardiseases

(familiarity)(1)Clinicalclassificationofprimaryglomerular

diseases1.Acuteglomerulonephritis.2.Rapidlyprogressive

glomerulonephritis.3.Chronicglomerulonephritis.4.

Asymptomatichematuriaor/andproteinuriawaspreviously

calledlatentglomerulonephritis.5.Nephroticsyndrome.(2)

Pathologicalclassificationofprimaryglomerulardiseases1.Mild

changeglomerulonephritis2.Focalsegmentaldisease3.Diffuse

glomerulonephritis

·Membranousnephropathy

·Proliferativenephritis√Mesangial

proliferativeglomerulonephritis√

Intracapillaryproliferative

glomerulonephritis√Mesangial

capillaryglomerulonephritis√

Crescenticandnecrotizing

glomerulonephritis

·Sclerosinggl

omerulonephritis4.

Unclassified

glomerulonephritis

鸿雁记忆技巧

补充：

1.微小病变型肾病

①好发于儿童

②可伴有镜下血尿

③对激素敏感

④电镜下广泛的肾小球脏层上皮细胞足凸融合—本病的诊断依据

Hongyanoriginal

memoryskills

补充：

1.Minimalchangenephropathy1.Preferstooccurin

children.2.Maybeaccompaniedbymicroscopiche

maturia.3.Sensitivetohormones.4.Extensivefoot-convex

fusionofglomerularvisceralepithelialcellsunderelectron

microscopy-thediagnosticbasisofthisdisease.

2.膜性肾病

①好发于中老年人。

②可伴有镜下血尿，一般无肉眼血尿。

③极易发生血栓栓塞并发症，尤其是肾静脉。

④光镜可见肾小球弥漫变，进而钉突形成；免疫病理显示IgG和C3细颗粒沿着肾小球毛细血管壁

沉积。

【经典例题】关于微小病变型肾病错误的是

A.电镜下广泛的肾小球脏层上皮细胞足凸融合

B.好发于儿童

C.可伴有镜下血尿

D.对激素敏感

E.常有高血压和肾功能减退

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