Chapter Ix The disease of urinary system 泌尿系统疾病 Zhang Zhi-Gang Department of Pathology, Shanghai Medical College, Fudan University
Chapter IX The disease of urinary system 泌尿系统疾病 Zhang Zhi-Gang Department of Pathology, Shanghai Medical College, Fudan University
Main types of urinary system diseases Inflammation ---glomerulonephritis pyelonephritis Stone -- nephrolithiasis hydronephrosis Tumor -- renal cell carcinoma, Wilms tumor transitional cell carcinoma
Main types of urinary system diseases • Inflammation --- glomerulonephritis , pyelonephritis • Stone --- nephrolithiasis , hydronephrosis • Tumor --- renal cell carcinoma, Wilms’ tumor , transitional cell carcinoma
The constitution of the urinary system Kidney and the urinary tract Kidney ---producing urine The nephron is the structural and functional unit of the kidney 肾小囊 肾小球 Nephron included renal corpuscle,小动脉 proximal convoluted tubule(PCT),小动脉 medullary loop, distal convoluted tubule( dci), and connected tubule.圖小管 The urinary tract 动脉 storing or eliminating urine 静脉 肾小管周围的 毛细血管网 Ureter. bladder. urethra 样 单位站枸示忘图
Kidney --- producing urine The nephron is the structural and functional unit of the kidney The urinary tract — storing or eliminating urine Ureter, bladder, urethra 一.The constitution of the urinary system Kidney and the urinary tract Nephron included renal corpuscle, proximal convoluted tubule (PCT), medullary loop, distal convoluted tubule(DCI), and connected tubule
nephron Glomerular and Bowman s capsule afferent Mesangial arteriole cell Visceral epithelia ce Endothelial ce gesang proximal area convoluted tubule
Glomerular and Bowman’s capsule mesangial area afferent arteriole nephron Mesangial cell Visceral epithelial cell Endothelial cell proximal convoluted tubule
Ultrastructure of glomerular The central of segments of glomeruli tuft is mesangial region with 1-3 mesangial cell and metrix filtrating membrane 系膜基质: Mesangial matrix The peripheral are wall of End 1e capillaries Endothelial GBM cell, GBM, podoc te
Ultrastructure of glomerular The central of segments of glomeruli tuft is mesangial region with 1～3 mesangial cell and metrix 系膜基质: mesangial matrix The peripheral are wall of capillaries.— Endothelial cell,GBM,podoc yte End Ep GBM Ms filtrating membrane
Glomerular filtrating membrane Fenestrated endothelium---70- 100nm Glomerular basement membrane (GBM) a meshwork of fine fibrils( Col-IV,laminin) embedded in an amorphous matrix(FN Epithelium--- podocyte epithelial slit 20-50 nm thin slit diaphragm 4 14 nm LD Capillarary lumen
Glomerular filtrating membrane • Fenestrated endothelium --- 70 ~ 100nm • Glomerular basement membrane (GBM) --- a meshwork of fine fibrils (Col- IV ,laminin) embedded in an amorphous matrix ( FN ) • Epithelium --- podocyte epithelial slit 20 ~ 50 nm, thin slit diaphragm 4 ~ 14 nm Capillarary lumen
肾球囊 Bowman's capsule Parietal epithelial cells-flat cells
● 肾球囊 Parietal epithelial cells — flat cells Bowman’s capsule
Etiology and pathogenesis of Glomerulonephritis Primary GN-- limited in kidney along Secondary gn-- associated with systemic diseases Primary GN: A group of hypersensitivity diseases Glomerular injury coused by immune complexes Two forms of abtibody associalted injury Circulating immune complex nephritis Immune complex nephritis in situ
二. Etiology and Pathogenesis of Glomerulonephritis Primary GN --- limited in kidney along Secondary GN --- associated with systemic diseases •Circulating immune complex nephritis •Immune complex nephritis in situ Primary GN: A group of hypersensitivity diseases Glomerular injury coused by immune complexes Two forms of abtibody associalted injury
Circulating immune complex nephritis exogenous: bacteria, virus, parasite foreign serum, drug, toxin endogenous: macroglobulin, thyroglobulin CEA
• Circulating immune complex nephritis exogenous: bacteria， virus， parasite foreign serum，drug，toxin endogenous: macroglobulin， thyroglobulin， CEA
Ag-Ab Immune Complex complex Glomerulonephritis Antigen Antibody