复旦大学内科学全套课件整理汇编

Decrease clearance of CIC
(B)in situ Immunocomplex
1. Native renal antigen glomerular basement membrane + anti- glomerular basement membrane antibody (anti- glomerular basement membrane glomerulonephritis)
glomerulosclerosis
Inflammation
• Mediators of inflammation
– A group of molecules which act as mediators of inflammation and complicated biological function
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
• primary glomerular diseases • secondary glomerular diseases • hereditary glomerular diseases
Immune mechanisms
Humoral Cell-mediated
Non-immune mechanisms
目录பைடு நூலகம்图
肾小球疾病 Glomerular Diseases
A group of diseases Pathological changes -- glomerular injury Clinical manifestations --proteinuria / hematuria
Complicated causes & mechanisms Various clinical manifestations Different prognosis Multiple treatment
Inflammation
Glomerular diseases
A. Immune mechanisms
(A)deposits of Circulating Immuno-Complex
(CIC)
circilation antigen+ antibody CIC kidney CIC/deposits
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
B. Cell-mediated immune mechanisms
minimal change glomerulopathy ?
C. Non –immune mechanisms
• glomerular hypertension • hyperlipidemia (LDL- Cho) • advanced glycosylation end products (protein)
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
• Mesangial cells, tubular cells, endothelial cells
Mediators of inflammation
active oxygen and active nitrogen lipids complements cytokines chemotatic factors adhesion molecules growth factors vasoactive substances
• • • • Persistence of antigen Clearance dysfunction of mesangial cells disability of mononuclear macrophage component or function defect of complements IC deposit > clearance
• Origin of inflammation mediators in kidney
– Extrinsic Cells in kidney
• infiltrative neutrophil, lymphocyte, mononuclear macrophage , platelet
– Intrinsic cells in kidney
Effects of the inflammation mediators
To arouse or promote - proliferation of cells - accumulation of extracellular matrix - changes of histological structure - expression of immunomodulating molecules and adhension molecules