狼疮性肾炎.pptx

-,患病率为40-200/10万女性与男性之比为10:1男性与女性狼疮,肾炎发生比例相同发病15-45岁,85%以上的患者发病年龄在55岁以前狼疮性肾炎概述在未选择的病例大约有25%-50%在SLE发病时就有临床肾脏疾病,病程中成人中的60%,儿童中的80%的SLE患者会患狼疮性肾炎。LN累计患病率:亚裔为55%、非裔51%、西班牙裔43%、高加索白人14%。非裔、西班亚裔和亚裔往往有更为严重的病例儿童易合并严重的肾炎,而老年人则较少。StichwehD,.CurrOpinRheumatol200416:577–587BogdanovicRPediatrNephrol200419:36–44OrtegaLM,etal:Lupus(2010)19,557–574InternationalSocietyofNephrology/RenalPathologySociety(2003)ClassificationofLupusNephritis(LN)IMinimalmesangialLNIIMesangialproliferativeLNIIIFocalLN*(<50%ofglomeruli)IVDiffuseLN*(50%ofglomeruli)Diffusesegmental(IV-lobal(IV-G)VMembranousLN,III+VIV+VVIAdvancedsclerosingLN(90%globallysclerosedglomeruliwithoutresidualactivity)(periodicacid–Schiff,×400).-densedeposits(×12,000).(Jonesmethenaminesilver,×100).Theglomerularendocapillaryproliferationisdiscretelysegmentalwithnecrotizingfeaturesandanearlycel-lularcrescent(Jonesmethenaminesilver,×400).-ingalargesubendothelialelectron-densedepositaswellasafewsmallsubepithelialdeposits(arrow)(×1200).-liferationwithinfiltratingneutrophilsandsegmentalwireloopdeposits(hematoxylinandeosin,×320).-graphshowingnumeroussubepithelialelectron-densedepositsaswellasmesangialdeposits(×5000).-mentmembranestowardtheurinaryspace(Jonesmethenaminesilver,×800).其他病理学改变间质-小管性改变血管炎:非炎症性坏死性血管炎,类似于多血管炎,TMA足细胞病:微小病变、FSGS或塌陷性肾小球病的10狼疮性肾炎的临床表现活动性沉渣蛋白尿大量蛋白尿NS高血压CrGFRDNA抗体补体其他classI无无或轻微无无classII无<1g/d极少见少见正常可存在classIII有>1g/d1/4-1/3