(三)Pathologic types producingnephrotic syndrome(NS)Pathologic basis:(1)Massive proteinuriaywallInjury of capillaryIncreasedIpermeability tothe plasma protein
(三)Pathologic types producing nephrotic syndrome(NS) Pathologic basis: (1) Massive proteinuria Injury of capillary wall Increased permeability to the plasma protein
(2)HypoalbuminemiaHeayyproteinuriaDepletion of serum albumin
(2) Hypoalbuminemia Heavy proteinuria Depletion of serum albumin
(3)Generalized edema1)HypoalbuminemiaLoss of colloid osmotic pressure of bloodAccumulation of fluid in theinterstitial tissue
(3) Generalized edema ① Hypoalbuminemia Loss of colloid osmotic pressure of blood Accumulation of fluid in the interstitial tissue
②the capacity of bloodlfiltration of glomeruluslaldosterone and antidiuretichormone secretionsodiumandWater retention
②the capacity of blood↓ filtration of glomerulus↓ aldosterone and antidiuretic hormone secretion↑ sodium and water retention
lipiduria(4) Hyperlipidemia and-Hyperlipidemia:Hypoalbuminemiaincreased synthesis of lipoproteinintheliver-Lipiduria:injury of capillary wallpermeabbilityto lipiprotein
(4) Hyperlipidemia and lipiduria ▪ Hyperlipidemia: Hypoalbuminemia increased synthesis of lipoprotein in the liver ▪ Lipiduria: injury of capillary wall permeabbility to lipiprotein↑
GN:1. Membranous(membranous nephropathy)(1) Most common cause of NS in adults(2)Features:Diffuse thickening of capillary wallImmune complex depositing alongepithelium (subepithelial) side
1. Membranous GN: (membranous nephropathy) (1) Most common cause of NS in adults (2) Features: ▪ Diffuse thickening of capillary wall ▪ Immune complex depositing along epithelium (subepithelial)side
3)EtiologyDPrimarylesion:85%unclearRelated diseases or factorsi Malignant epithelial tumors:carcinoma of lung,colonmelanoma (5-10%).iiChronic hepatitis B, syphilis,malaria, infectious disease
(3) Etiology ① Primary lesion: 85% unclear ② Related diseases or factors: ▪ ⅰ Malignant epithelial tumors: carcinoma of lung , colon melanoma (5-10%) ▪ ⅱ Chronic hepatitis B, syphilis, malaria, infectious disease
.iiiSLE:5-15%-ivExposure to inorganic salts:and metalmercuryDrugs: 1-7% patients withrheumatiodarthritis treatedbypenicillamineviMetabolic disorders:diabites ,thyroiditis
▪ ⅲ SLE:5-15% ▪ ⅳ Exposure to inorganic salts: mercury and metal ▪ ⅴ Drugs: 1-7% patients with rheumatiod arthritis treated by penicillamine ▪ ⅵ Metabolic disorders: diabites , thyroiditis
(4)Pathogenesis@ Chronic immune complex GNanti-glomerularAgautoAbformation ofimmunecomplex and complement in thesubepithelial deposits
(4) Pathogenesis ① Chronic immune complex GN anti-glomerular Ag auto Ab formation of immune complex and complement in the subepithelial deposits
2Genetic susceptibilityis suggested by theincreasedprevalence0f HLA-DR3
② Genetic susceptibility is suggested by the increased prevalence of HLA-DR3