肾小球疾病 Glomerular diseases 丁小强 复旦大学附属中山医院
肾小球疾病 Glomerular Diseases 丁小强 复旦大学附属中山医院
a group of diseases Patho logical changes glomerular InJury Clinical man i festations --prote inur ia/ hematur ia Comp/icated causes mechanisms Var ious clinical manifestations Different prognosis Multiple treatment
Pathological changes -- glomerular injury Clinical manifestations --proteinuria / hematuria A group of diseases Complicated causes & mechanisms Various clinical manifestations Different prognosis Multiple treatment
primary glomerular diseases secondary glomerular diseases hereditary glomerular diseases
• primary glomerular diseases • secondary glomerular diseases • hereditary glomerular diseases
Immune mechanisms Non-immune Humoral Cell-mediated mechanisms Inflammation Glomerular diseases
Immune mechanisms Humoral Cell-mediated Non-immune mechanisms Inflammation Glomerular diseases
A。 Immune mechanisms (A) deposits of Circulating Immuno-Complex CIC) circlation antigen+ antibody CIC kidney CIC/deposits
A. Immune mechanisms (A)deposits of Circulating Immuno-Complex (CIC) circilation antigen+ antibody CIC kidney CIC/deposits
antigen extrinsic drugs--nonhomologous serum, penicillin foods--xenogenic protein pathogen-specific serotypes streptococci, HBV.HCV intrinsic nucleus (SLE) cytoplasm (ANCA) cellular membrane antigen of tumor antigen of thyroid
antigen extrinsic drugs--nonhomologous serum, penicillin foods—xenogenic protein pathogen—specific serotypes streptococci, HBV, HCV intrinsic nucleus（SLE) cytoplasm（ANCA） cellular membrane antigen of tumor antigen of thyroid
Why does cic deposit in the glomeruli? Large area of glomerular capillaries more chances to contact Net structure of cic easy to deposit and settle down Clearance dysfunction of mesangial cells disability of mononuclear macrophage, component or function defect of complements Decrease clearance of cic
Why does CIC deposit in the glomeruli? • Large area of glomerrular capillaries --more chances to contact • Net structure of CIC --easy to deposit and settle down • Clearance dysfunction of mesangial cells, disability of mononuclear macrophage, component or function defect of complements Decrease clearance of CIC
(B)in situ Immunocomplex Native renal antigen glomerular basement membrane anti-glomerular basement membrane antibody (anti- glomerular basement membrane glomerulonephritis) 2. Antigens trapped or planted DNA+ anti-DNA antibody Lupus Nephritis)
(B)in situ Immunocomplex 1. Native renal antigen glomerular basement membrane + anti- glomerular basement membrane antibody (anti- glomerular basement membrane glomerulonephritis) 2. Antigens trapped or planted DNA+ anti-DNA antibody (Lupus Nephritis)
Balance between the deposit and clearance of ic determines the situation of the diseases Persistence of antigen Clearance dysfunction of mesangial cells disability of mononuclear macrophage component or function defect of complements IC deposit clearance
Balance between the deposit and clearance of IC determines the situation of the diseases • Persistence of antigen • Clearance dysfunction of mesangial cells • disability of mononuclear macrophage • component or function defect of complements IC deposit > clearance
B. Cell-mediated immune mechanisms minimal change glomerulopathy
B. Cell-mediated immune mechanisms minimal change glomerulopathy ?