Three highs in the glomerulus
Introduction
Introduction 1. Minimal lesion nephropathy (MCD); 2. Secondary glomerular sclerosis; 3. Focal segmental glomerulosclerosis. Its pathological features are the presence of lipoprotein emboli in the glomerular capillaries and extrarenal lipoprotein embolism. The clinical manifestations were similar to type III hyperlipidemia with elevated plasma apolipoprotein E (apo E). The disease is an independent glomerular disease, and in the same year the disease was named lipoprotein glomerulopathy. However, lipoprotein glomerulopathy does not improve glomerular lesions by lowering blood lipids. It is currently believed that this disease is a rare disease in which the glomerular type III is limited to the lipidation of the kidney.
Cause
Cause
When the nephron is destroyed to a certain amount, the metabolic waste excretion load of the remaining "healthy" nephron is increased to maintain the normal needs of the body. Thus compensatory hyperimplantation of glomerular capillaries, high pressure and high filtration ("three high" in the glomerulus). Lipoprotein glomerulopathy mainly affects the kidney and is mainly caused by glomerular damage. Proteinuria was present in all patients, and some gradually progressed to proteinuria in the range of nephropathy, and a few cases were accompanied by microscopic hematuria. Although plasma cholesterol, triglyceride and VLDL increase in patients with this disease, there is often no extrarenal manifestation, and lipoprotein does not form an embolism outside the kidney. Most patients show resistance to hormonal therapy and slowly progress to renal failure.
Examine
an examination
Related inspection
Glomerular filtration fraction (GFF) glomerular function test
High pressure, high perfusion and high filtration ("three high") in the glomerulus can accelerate glomerular sclerosis; glomerular lesions with systemic hypertension, massive proteinuria, and inappropriate protein and phosphorus intake in renal insufficiency Etc., can cause or promote glomerular sclerosis. At the same time, the effects of hyperlipidemia and certain cytokines have aggravated the progression of glomerular sclerosis.
The "three highs" in the glomerulus can cause: 1 glomerular epithelial cell foot process fusion, mesangial cells and matrix significantly proliferated, glomerular hypertrophy, followed by sclerosis; 2 glomerular endothelial cell injury, induce platelet aggregation, Lead to microthrombus formation, damage glomerulus and promote sclerosis; 3 increased glomerular permeability, which increases proteinuria and damages tubulointerstitial.
Check: proteinuria, correct occult blood, lower serum creatinine, urea nitrogen.
Diagnosis
Differential diagnosis
Differential diagnosis of "three highs" in the glomerulus:
1. Minimal lesion nephropathy (MCD): may be misdiagnosed due to insufficient tissue or lack of access to the paramedullary nephrons. However, MCD rarely shows hypertension and hematuria, and most patients are sensitive to hormone therapy. In addition, the following pathological features contribute to the difference between MCD and FSGS: 1 the glomerular volume of the former is increased, while the glomerular volume of the latter is different; 2 the former is characterized by diffuse foot process fusion, while the latter is segmental 3; the latter can be seen in the vacuolar degeneration of visceral epithelial cells.
2. Secondary glomerulosclerosis: In addition to the characteristics of the primary disease, the secondary FSGS caused by other diseases include histological features including: glomerular sclerosis, renal tubular wall thickening, Peripheral fibrosis, tubulointerstitial lesions showed patchy distribution, and a large amount of inflammatory cell infiltration was observed in the interstitium. These histological differential diagnosis has great defects. In essence, it is difficult to make a correct differential diagnosis without relying on medical history, clinical manifestations and laboratory tests. In particular, primary and secondary FSGS cannot be distinguished by histomorphological features.
3. Focal segmental glomerulosclerosis: only part of the glomerular involvement, and limited to part of the glomerular lobule or capillary vasospasm. The lesion is characterized by glomerular sclerosis with a focal and segmental distribution. Focal glomerulonephritis is a common cause of nephrotic syndrome.
