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泌尿系统和男性生殖系统疾病
Diseasesofurinarysystemandmalegenitalsystem
NephrologyUrology
OutlineGlomerulonephritis(GN)TubulointerstitialnephritisUrinaryoutflowobstructionTumorsofurinarysystemProstateDisease,TestisandPenisTumor
Theincidencerateofchronickidneydisease(CKD)is9.4%to11.8%inChina,thereisonepatientforeverytenpeopleTheoccurrenceisoccult,20%ofthepatientsatdiagnosisareonlatestageThesecondThursdayofMarchisdeclaredastheWorldKidneyDay(WKD).March12,2015isthe10thWKD.ThetopicforWKD2015is“KidneyHealthforAll”
EtiologyofglomerulardiseasesPrimary(majority):diseaseprocessappearstostartwithintheglomeruliSecondary:diseaseprocessissecondarytosystemicdisease(SLE,vasculardiseases,diabetesmellitus,amyloidosis)Hereditary:congenitaldiseases(Alportsyndrome,Fabry’sdisease)
Primaryglomerulonephritiskidneyistheonlyorpredominantorganinvolved
EtiologyandPathogenesisImmunemechanismsunderliethemajorityofprimaryGN.Themostcommonmechanismisantibody-medicatedinjury.Twobasicformsofantibody-associatedinjury:Injuryresultingfromdepositionofsolublecirculatingantigen-antibodycomplexesintheglomeruliInjurybyantibodiesreactinginsituwithintheglomeruli
CirculatingImmuneComplexNephritisCausedbythetrappingofcirculatingantigen-antibodycomplexeswithinglomeruliTheantibodieshavenoimmunologicspecificityforglomerularconstituentsTypeⅢhypersensitivityreactionTheantigensmaybeofendogenousorexogenousorigins
CirculatingImmuneComplexNephritisTheelectron-densedepositslieinthemesangium,betweentheendothelialcellsandtheGBM(subendothelialdeposits)orbetweentheGBMandthepodocytes(subepithelialdeposits)Thedepositsmaybedegradedbymonocytesandmesangialcells
InSituImmuneComplexDepositionAntibodiesreactdirectlywithintrinsictissueantigen,orantigens“planted”intheglomerulifromthecirculation.A
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