肾脏活体组织病理检查的诊断意义课件.ppt

1、肾脏活体组织病理检查的诊断意义 孙彬南京医科大学第一附属医院肾脏科肾脏活体组织病理检查的诊断意义1肾脏活体组织病理检查的诊断意义2肾脏活体组织病理检查的诊断意义3肾脏活体组织病理检查的诊断意义4肾脏活体组织病理检查的诊断意义5肾脏活体组织病理检查的诊断意义6肾脏活体组织病理检查的诊断意义7肾脏活体组织病理检查的诊断意义8肾脏活体组织病理检查的诊断意义9肾脏活体组织病理检查的诊断意义10肾脏活体组织病理检查的诊断意义11Normal Human Kidney肾脏活体组织病理检查的诊断意义12Normal Human Kidney肾脏活体组织病理检查的诊断意义13Normal Human Kidn

2、ey肾脏活体组织病理检查的诊断意义14Normal Human Kidney肾脏活体组织病理检查的诊断意义15Normal Human Kidney肾脏活体组织病理检查的诊断意义16Normal Human Kidney肾脏活体组织病理检查的诊断意义17Normal Human Kidney肾脏活体组织病理检查的诊断意义18Normal Human Kidney肾脏活体组织病理检查的诊断意义19肾脏活体组织病理检查的诊断意义20肾脏活体组织病理检查的诊断意义21肾脏活体组织病理检查的诊断意义22肾脏活体组织病理检查的诊断意义23Podocytes in minimal change NS 肾脏

3、活体组织病理检查的诊断意义24肾脏活体组织病理检查的诊断意义25肾脏活体组织病理检查的诊断意义26The electron micrograph is from a patient with minimal change glomerulopathy and shows almost complete effacement of the visceral epithelial foot processes.There is condensation of the epithelial cytoskeleton near the basement membrane.肾脏活体组织病理检查的诊断意义

4、27Normal podocytes Podocytes in minimal change NS 肾脏活体组织病理检查的诊断意义28肾脏活体组织病理检查的诊断意义29肾脏活体组织病理检查的诊断意义30肾脏活体组织病理检查的诊断意义31肾脏活体组织病理检查的诊断意义32FSGS肾脏活体组织病理检查的诊断意义33FSGS肾脏活体组织病理检查的诊断意义34FSGS肾脏活体组织病理检查的诊断意义35FSGS肾脏活体组织病理检查的诊断意义36FSGS肾脏活体组织病理检查的诊断意义37FSGS肾脏活体组织病理检查的诊断意义38FSGS肾脏活体组织病理检查的诊断意义39FSGS肾脏活体组织病理检查的诊断意

5、义40FSGS肾脏活体组织病理检查的诊断意义41FSGS肾脏活体组织病理检查的诊断意义42FSGS肾脏活体组织病理检查的诊断意义43肾脏活体组织病理检查的诊断意义44肾脏活体组织病理检查的诊断意义45肾脏活体组织病理检查的诊断意义46肾脏活体组织病理检查的诊断意义47肾脏活体组织病理检查的诊断意义48肾脏活体组织病理检查的诊断意义49肾脏活体组织病理检查的诊断意义50肾脏活体组织病理检查的诊断意义51肾脏活体组织病理检查的诊断意义52肾脏活体组织病理检查的诊断意义53肾脏活体组织病理检查的诊断意义54肾脏活体组织病理检查的诊断意义55肾脏活体组织病理检查的诊断意义56肾脏活体组织病理检查的诊断

6、意义57肾脏活体组织病理检查的诊断意义58肾脏活体组织病理检查的诊断意义59肾脏活体组织病理检查的诊断意义60肾脏活体组织病理检查的诊断意义61肾脏活体组织病理检查的诊断意义62肾脏活体组织病理检查的诊断意义63肾脏活体组织病理检查的诊断意义64Moving from urinary space to capillary limen there is the urinary space,effaced foot processes,the lamina lucida externa,lamina densa,the subendothelial electron dense deposits

7、which are lying adjacent to the little fingers of mesangial cytoplasm that have extended into the subendothelial zone,new basement membrane material,and endothelial cell with pores.肾脏活体组织病理检查的诊断意义65This electron micrograph shows the urinary space,the effaced foot processes,the original basement memb

8、rane,and conspicuous subendothelial deposits.肾脏活体组织病理检查的诊断意义66Immunofluorescence microscopy(slide 47)typically demonstrates peripheral granular or band-like staining that may outline the hypersegmentation.In many patients with type I MPGN,C3 will be the most conspicuous component in the deposits,esp

9、ecially in the idiopathic childhood variant.Patients with MPGN often have hypocomplementemia and a circulating autoantibody called C3 nephritic factor,which binds to the C3 convertase of the alternative pathway.肾脏活体组织病理检查的诊断意义67Hepatitis C infection is a common cause for type I membranoproliferative

10、 glomerulonephritis,especially if it is accompanied by mixed cryoglobulinemia.When mixed cryoglobulinemia is present,sometimes as shown in,there will be globular accumulations of cryoglobulin in the capillary lumens.These can be seen by light microscopy as hyaline thrombi.肾脏活体组织病理检查的诊断意义68Sometimes,

11、when the immune complexes are derived from cryoglobulins,there will be tubular arrays in the deposits that have about a 30-40 nanometer diameter.When these immunotactoids are present in the absence of cryoglobulinemia,the appropriate diagnostic term is immunotactoid glomerulopathy 肾脏活体组织病理检查的诊断意义69T

12、his is an uncommon disease that is sometimes accompanied by a B-cell neoplasms.Immunotactoid glomerulopathy should not be confused with the more common disease called fibrillary glomerulonephritis,which is characterized ultrastructurally by approximately 20 nm diameter fibrils 肾脏活体组织病理检查的诊断意义70肾脏活体组

13、织病理检查的诊断意义71The PAS(on left)and H&E-stained sections in slide 52 demonstrates thickening of the basement membrane and capillary wall,respectively.肾脏活体组织病理检查的诊断意义72The diagram in illustrates the dense transformation of the basement membrane that causes the thickening.肾脏活体组织病理检查的诊断意义73The electron mic

14、rograph shows the urinary space,an expanded mesangial region with a little bit of dense material in the increased matrix,and capillary basement membrane with stretches of normal lamina densa and zones of dense transformation.肾脏活体组织病理检查的诊断意义74shows GBM as well as mesangial deposits.These dense deposi

15、ts are not subepithelial or subendothelial,but rather are within the basement membrane.肾脏活体组织病理检查的诊断意义75there is intense staining for C3,typically with almost no staining for immunoglobulin.The capillary wall staining is usually linear or bilinear.There often are spherical or ring-shaped mesangial d

16、eposits that correspond to the mesangial dense deposits observed by electron microscopy.肾脏活体组织病理检查的诊断意义76肾脏活体组织病理检查的诊断意义77肾脏活体组织病理检查的诊断意义78肾脏活体组织病理检查的诊断意义79肾脏活体组织病理检查的诊断意义80肾脏活体组织病理检查的诊断意义81肾脏活体组织病理检查的诊断意义82肾脏活体组织病理检查的诊断意义83肾脏活体组织病理检查的诊断意义84肾脏活体组织病理检查的诊断意义85肾脏活体组织病理检查的诊断意义86肾脏活体组织病理检查的诊断意义87肾脏活体组织病理

17、检查的诊断意义88肾脏活体组织病理检查的诊断意义89肾脏活体组织病理检查的诊断意义90肾脏活体组织病理检查的诊断意义91肾脏活体组织病理检查的诊断意义92肾脏活体组织病理检查的诊断意义93肾脏活体组织病理检查的诊断意义94肾脏活体组织病理检查的诊断意义95StageProteinuriaGlemerular filtrationPathologyInormalnormal-hyperfiltrationnormal-mild diffuse lesionIImicroalbuminurianormal-hyperfiltrationnormal-moderate diffuse lesionw

18、ith occasional nodular lesionIIIApersistentnormalmoderate diffuse lesionwith frequent nodular lesionIIIBpersistent(1g=day)low(=60 ml/min)severe diffuse lesionwith frequent nodular lesionIVpersistentvery lowend-stage kidneyVHemodialysisDiabetic Nephropathy肾脏活体组织病理检查的诊断意义96Diabetic Nephropathy肾脏活体组织病理检查的诊断意义97Diabetic Nephropathy肾脏活体组织病理检查的诊断意义98Diabetic Nephropathy肾脏活体组织病理检查的诊断意义99Diabetic Nephropathy肾脏活体组织病理检查的诊断意义100Diabetic Nephropathy肾脏活体组织病理检查的诊断意义101Diabetic Nephropathy肾脏活体组织病理检查的诊断意义102Diabetic Nephropathy肾脏活体组织病理检查的诊断意义103Diabetic Nephropathy肾脏活体组织病理检查的诊断意义104