西安交通大学医学院泌尿系统疾病课件 IgAN.pptVIP

IgA Nephropathy Nephrology Department IgA N Overview IgAN is the major disease of dialysis and kidney transplantation. 10%-20% of IgA came to uremia in 10 years. Secondary IgA Deposited Diseases Multi-systemic diseases：Henoch-Schonlein Purpura, SLE, psoriasis, rheumatoid arthritis Oncology：Lung cancer Infectious diseases: bacteria, virus Toxoplasmosis(弓形虫病),gafeira（麻风病） Others：alcoholic liver disease Pathogenesis(I) Immune disorder IgA mucous immune system: PIgA (intestine, salivary gland, respiratory tract, tonsil) whole body immune system: MIgA( bone marrow, lympha nodes, spleen) Hereditary factor race, geographic distribution Pathogenesis(II) Circulating PIgA1 \ IgA1IC has a highly affinity with IgA1 binding protein or receptor of mesangum pathology(I) Light microscopy: A focal glomerulonephritis with diffuse mesangial IgA deposits and proliferation of mesangial cells. IgG and C3 can also be seen in the mesangium of all glomeruli. Cellular crescents, interstitial inflammation may be evident in severe cases. At the late stage local segmental sclerosis, proliferitive sclerotized nephritis be seen. pathology(II) Immunofluorescence： IgA distributed as granula or clumping in glomeruli mesangial area or with capillary ,commonly with C3 deposite. Electron microscopy: Electron dense mateiral as huge mass deposite in mesangial region. Clinical classification Lab test Diagnosis The immunopathology of renal biopsy is the standard for diagnosis of IgAN. IgA depositing in the glomerular mesangial region detected by immunoflorescence microscopy. . Differential diagnosis Prognosis IgA N about 1%-2% progress to CRF. Bed prognosis: MaleFemale 35y,with persistence hypertension, serious renal pathological change proteinur