1、继发性肾小球肾炎继发性肾小球肾炎 病因发病机制：病因发病机制：粘膜损伤 IgA形成 含IgA的大分子的免疫复合物沉积于肾小球 病变特点：病变特点：免疫病理：以IgA为主的免疫球蛋白和C3沉积于系膜区。光学显微镜：局灶性或弥漫性的，除膜性肾小球肾炎以外的各型肾小球肾炎。临床表现：临床表现：可出现血管炎和紫癜及各型肾炎综合征。继发性肾小球肾炎2继发性肾小球肾炎3继发性肾小球肾炎4继发性肾小球肾炎5继发性肾小球肾炎6继发性肾小球肾炎7继发性肾小球肾炎8 病因发病机制：病因发病机制：自身免疫性疾病。含抗核抗体、抗细胞浆抗体、抗球蛋白抗体、抗细胞膜抗体等多种免疫复合物，沉积于肾小球 病变特点：病变特点：
2、免疫病理：含IgG、IgA、IgM、C3、C4、C1q的多种免疫复合物，沉积于肾小球的各个部位。光学显微镜：局灶性或弥漫性的，各型肾小球肾炎。临床表现：临床表现：可出现全身(心、肝、脑、关节、皮肤等）多系统病变及各型肾炎综合征。继发性肾小球肾炎9继发性肾小球肾炎10继发性肾小球肾炎11继发性肾小球肾炎12继发性肾小球肾炎13继发性肾小球肾炎14继发性肾小球肾炎15 各型GN的演变关系毛细血管内增生性毛细血管内增生性GN 膜增生性膜增生性GN局灶性局灶性GN系膜增生性系膜增生性GN 微小病变性微小病变性GNFSGS膜性膜性GN继发性肾小球肾炎16 glomerulinephritis,Endoc
3、apillary proliferative GN,Membranous GN,Mesangioproliferative GN,Membranoproliferative GN,Crescentic GN,Minimal change GN,Focal GN,Sclerosing GN继发性肾小球肾炎17三、急性肾小管坏死(acute tubular necrosis)由于休克或中毒导致的肾小管上皮细胞坏死，主要侵犯各段肾小管，主要临床表现为少尿、无尿和肾功能衰竭。继发性肾小球肾炎18病因发病机制:休克，血压降低，肾缺血，肾小管缺血性坏死；毒性物质在肾小管浓缩，直接伤害肾小管上皮细胞。病理变
4、化:肾小管上皮凝固性坏死，细胞碎片堵塞管腔，肾间质水肿；后期；肾小管上皮再生。继发性肾小球肾炎19 肾小球缺血 肾小球滤过率 肾小管上皮坏死 细胞碎片堵塞 尿液返流 肾间质水肿 少尿或无尿 后期，再生的肾小管上皮功能不全 多尿和等比重尿休克或中毒 肾缺血临床病理联系:继发性肾小球肾炎20继发性肾小球肾炎21继发性肾小球肾炎22继发性肾小球肾炎23CONCLUSION Acute tubular necrosis:tubular epithelial cells show diffuse coagulation necrosis,caused by renal ischemia or poiso
5、ning,often occur acute renal failure.KEY WORD:Acute tubular necrosis继发性肾小球肾炎24继发性肾小球肾炎25病原体：大肠杆菌、链球菌、葡萄球菌、绿脓杆菌、霉菌等感染途径：上行性(大肠杆菌为主)；血源性(少见,烈性化脓菌为主)诱发因素：下尿路梗阻;重病体弱,长期卧床患者继发性肾小球肾炎26 病理变化:继发性肾小球肾炎27继发性肾小球肾炎28继发性肾小球肾炎29继发性肾小球肾炎30继发性肾小球肾炎31继发性肾小球肾炎32继发性肾小球肾炎33继发性肾小球肾炎34继发性肾小球肾炎35CONCLUSION Pyelonephritis:
6、is a suppurative inflammation,is caused by infection of suppurative bacterium.The pelvis,interstitium and tubules is major injury site.Morphology:focal suppurative inflammation(phlegmonous inflammation or abscesses).Its clinical manifestations include:fever,malaise,flank pain,dysuria,frequency and u
7、rgency,pyuria and white cell casts.继发性肾小球肾炎36继发性肾小球肾炎37继发性肾小球肾炎38继发性肾小球肾炎39继发性肾小球肾炎40继发性肾小球肾炎41CONCLUSION Allergic interstitial nephritis:is a nonsuppurative inflammation,is caused by drug allergy.The interstitium and tubules is major injury site.Morphology:mononuclear cells(lymphocytes and mono-pha
8、gocytes)and/or eosinocytes diffuse infiltrate in interstitium of both kidneys,so often occur acute renal failure.KEY WORD:Pyelonephritis,Allergic interstitial nephritis继发性肾小球肾炎42继发性肾小球肾炎43继发性肾小球肾炎45CONCLUSION Renal cell carcinoma:Histogenesis:proximal tubular cells.Morphology:clear-cancerous cells a
9、nd trabecularism.Clinical features:renal neoplasm and hematuria occur in 60th and 70th decades of men.Behavior:malignant tumor,often hematogenous metastasis.继发性肾小球肾炎46(2)肾母细胞瘤 (nephroblastoma,Wilm tumor)组织发生:肾胚芽组织病理特点:肾内巨大肉瘤样肿块;由未分化的胚芽组织、间胚叶性间质和幼稚的肾小球和肾小管组成生物学特性:婴幼儿好发;早期血行转移至肺、肝等继发性肾小球肾炎47继发性肾小球肾炎48
10、继发性肾小球肾炎49继发性肾小球肾炎50CONCLUSION Nephroblastoma(Wilms tumor):Histogenesis:renal blastem.Morphology:blastem tissue,abortive glomeruli and tubules,mesenchymal tissue.Clinical features:renal neoplasm and hematuria occur in 2-4 years childhood.Behavior:malignant tumor,often hematogenous metastasis.继发性肾小球肾
11、炎51继发性肾小球肾炎52移行上皮癌:有一定异型性的癌组织呈伸出性和浸润性生长；依癌组织的异型性，分为I、II、III级生物学特性:中老年好发;易复发；以局部浸润和淋巴路转移常见继发性肾小球肾炎53继发性肾小球肾炎54继发性肾小球肾炎55继发性肾小球肾炎56继发性肾小球肾炎57继发性肾小球肾炎58CONCLUSION Urothelial tumors:Histogenesis:transitional cells.Morphology:papilloma and various grades carcinoma.Clinical features:hematuria occur in adult and old men.Behavior:benign papilloma easily recur and become malignant,transitional carcinoma which is often multi-focus growth,and progresisive infiltration,invasion and destruction of the surrounding tissue.KEY WORD:Renal cell carcinoma,Nephroblastoma,Urothelial tumors继发性肾小球肾炎59
