性肾病三血管疾病四中毒性疾病肾小管五尿路结石（精品）课件.ppt

Diseases of urinary system Zhang Hongying How to learn systemic pathology (pathology of urinary system) ? basic science (anatomy, histology, physiology, immunology…) general pathology systemic pathology clinic practice *correlations between structural and functional changes (clinicopathologic correlations) Functions of the kidneys Eliminating metabolic waste products Regulating fluid and electrolyte balance Influencing acid-base balance Secreting hormones (prostaglandins, erythropoietin, 1,25-dihydroxycholecalciferol, renin) Outline Glomerulonephritis Tubulointerstitial nephritis Diseases of the lower urinary tract Tumors of urinary system Etiology of glomerular diseases Primary(majority):disease process appears to start within the glomerulus Secondary:disease process is secondary to systemic disease (SLE, vascular diseases, diabetes mellitus) Hereditary:congenital diseases ( Fabry’s disease) Primary glomerulonephritis kidney is the only or predominant organ Mechanism of glomerular injury Circulating immune complex nephritis immune complex nephritis in situ Cell-mediated immunity Other mechanisms Mechanism of glomerular injury Circulating immune complex nephritis immune complex nephritis in situ Cell-mediated immunity Other mechanisms Steps in diagnoses of glomerular lesions Clinical presentation Renal biopsy Clinical manifestations Hematuria (red blood cells in urine) Proteinuria (protein lost in urine) Oliguria or anuria (no urine flow) Edema Hypertension Urinary casts (cell casts, granular casts, hyaline casts) Azotemia (waste products accumulation) Uremia (with autotoxication symptom) Clinical presentations Acute nephritic syndrome: acute onset, blood pressure ，hematuria, proteinuria, edema, azotemia Rapidly progressive nephritic syndrome: abrupt or insidious onset of hematuria, proteinuria, anemia and rapidly progressing renal failure Clinical presentations Nephrotic syndrome: heavy pr