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1、GlomerularDiseasesForInternalMedicine1醫(yī)學(xué)Theperipheralportionofaglomerularlobule2醫(yī)學(xué)GlomerularDiseasesClassificationPrimarySecondaryHereditary3醫(yī)學(xué)Pathogenesis4醫(yī)學(xué)ImmunologicglomerularinjuryHumoralantibody-mediatedCellularantibody-independent5醫(yī)學(xué)Antibody-mediatedCirculatingautoantibodie
2、swithintrinsicautoantigens:eg.anti-GBMdiseaseInsituformationofimmunecomplexs/circulationgantibodieswithextrinsicantigensthathavebeen“planted”withintheglomerulus:eg.PostinfectiousglomerulonephritisANCA/AECAassociated:nodisernibleimmunecomplexesintheglomerularparenchyma6醫(yī)學(xué)Cellularan
3、tibody-independentglomerularinjuryLesswelldefinedInitiatorsofinjuryinpauci-immuneglomerulonephritis,whichsharethedownstreammediatorswiththeantibody-dependentinjurySolublefactorsfromTcells:inMCDandprimaryFSGS7醫(yī)學(xué)NonimmunologicglomerularinjuryMetabolicHemodynamictoxic8醫(yī)學(xué)immunologichu
4、moralcellularnon-immunologicinflammationGlomerularinjury9醫(yī)學(xué)Clinicopathologiccorrelatesinglomerulardisease10醫(yī)學(xué)Majorclinicopathologicentities(cont’d)NephroticsyndromeGlomerularfiltrationbarrieraffectedNephrotic-rangeproteinuria>=3.5g/24hHypoalbuminemia,edema,hyperlipidemia,andlipidu
5、ria,andaprothromboticstateMembranousglomerulopathyMinimalchangedisease(MCD)FSGSMembranoproliferative:hybridlesionofnephriticandnephroticfeatures11醫(yī)學(xué)OthersGlomerulardepositiondiseases:extravasculardepositionofparaproteinorfibrillarmaterialThromboticmicroangiopathies:thrombiwithinth
6、erenalmicrovasculature12醫(yī)學(xué)PrimaryinsultInflammatory√Metabolic√Hemodynamicormechanic√ToxicInfectiousMayoverlapMayinducesimilarclinicopahtologicpresentations13醫(yī)學(xué)病變部位系膜mesangium系膜細(xì)胞mesangialcell系膜基質(zhì)mesangialmatrix基膜basementmembrane上皮細(xì)胞足細(xì)胞podocyte、足突footprocess內(nèi)皮細(xì)胞14醫(yī)學(xué)Theperipheralpor
7、tionofaglomerularlobule15醫(yī)學(xué)基本病變增生proliferation硬化sclerosis16醫(yī)學(xué)1.輕微腎小球病變（MinorLesion)無特異性病變 光鏡下可見輕度系膜細(xì)胞增生和 系膜基質(zhì)增多輕微病變腎病minimalchangedisease，MCD輕度系膜增殖性腎小球腎炎毛細(xì)血管內(nèi)增殖性腎小球腎炎恢復(fù)期其它17醫(yī)學(xué)MCD（左）正常，（右）上皮細(xì)胞足突廣泛融合、消失18醫(yī)學(xué)2.局灶節(jié)段性病變(1)局灶節(jié)段性增殖性腎小球腎炎focalandsegmentalproliferativeglomerulonephritis(2)局
8、灶節(jié)段性腎小球硬化focalandsegmentalglomeru
