Weening Jan J, Ronco Pierre, Remuzzi Giuseppe
Departments of Pathology Erasmus MC, Rotterdam & Tergooiziekenhuizen Blaricum, Hilversum, The Netherlands.
Contrib Nephrol. 2013;181:12-21. doi: 10.1159/000348639. Epub 2013 May 8.
Glomerular injury can be caused by numerous insults including hemodynamics, infections and immunity, hereditary and metabolic diseases, and toxicity. Basic and translational experimental studies in combination with clinical research in patients with renal disease have advanced our understanding of the etiology and pathogenesis of many forms of glomerulonephritis. This new knowledge has facilitated classification and treatment and has contributed to a better outcome of patients with renal disease. Since renal disease almost without exception leads to systemic cardiovascular complications, these advances are also of general health interest. Here, we shall briefly review general principles in the pathology of glomerular injury and discuss recent developments in the study of podocytopathies; membranous glomerulopathy; ANCA-associated vasculitis; C3 glomerulopathies and the role of complement in endothelial injury; and the prognostic value of the renal biopsy in predicting long-term outcome in lupus nephritis, vasculitis and IgA nephropathy.
肾小球损伤可由多种损害因素引起，包括血流动力学、感染与免疫、遗传和代谢性疾病以及毒性作用。基础和转化性实验研究与肾病患者的临床研究相结合，加深了我们对多种形式肾小球肾炎病因和发病机制的理解。这些新知识促进了分类和治疗，并有助于改善肾病患者的预后。由于肾病几乎无一例外会导致全身性心血管并发症，因此这些进展也引起了人们对整体健康的关注。在此，我们将简要回顾肾小球损伤病理学的一般原则，并讨论足细胞病、膜性肾小球病、抗中性粒细胞胞浆抗体相关血管炎、C3肾小球病以及补体在内皮损伤中的作用的研究进展；以及肾活检在预测狼疮性肾炎、血管炎和IgA肾病长期预后方面的价值。
