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2017年1月5日 星期四

[醫如往常] Senior Clerkship Day 108: Pathology: Kidney

林醫師
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Sinus fat
Papilla pelvis
Pyramid

Gerota's fascia
T12-L3
Perirenal, pararenal fat

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Endothelial fenestrae 70-100nm
Mesangial

GBM
Lamina rara interna
Lamina densa
Lamina rara externa

Podocytes foot process 20-30nm visceral epithelium
Parietal epithelium
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Macula densa of distal tubule chemoreceptor
JGA baroreceptor
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90% renal cortex composes tubules
Proximal tubule, brush border 比較紅

Shock segments
Toxin continuous
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Interstitium
Ccr, BUN
Per min
1000cc renal artery
900cc renal vein
GFR 100
Urine 1
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Renal artery
Seg
Interlobar
Arcuate
Intralobar
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Percutaneous biopsy

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HE
Silver
Masson Trichrome
PAS
3um

Immunofluorescence
IgG, IgM, IgA, C3, C1q, kappa, lambda
Tubules deposition nonspecific
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Subepi.  Membrane
Mesengial IgA
Subendo lupus, MPGN

DIf
Cryo
Acetone
PBS
FITC
PBS
PermaFluor
Dark

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Goodpasture disease
Goodpasture syndrome (GPS; also known as Goodpasture’s disease, antiglomerular basement antibody disease, or anti-GBM disease) is a rare autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs and kidney failure. It is thought to attack the alpha-3 subunit of type IV collagen, which has therefore been referred to as Goodpasture's antigen.[1] Goodpasture syndrome may quickly result in permanent lung and kidney damage, often leading to death. It is treated with immunosuppressant drugs such as corticosteroids and cyclophosphamide, and with plasmapheresis, in which the antibodies are removed from the blood.
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EM
Glutaraldehyde
1um, 50-70nm for EM
Thin basement disease
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RPGN Ccr兩倍 in  3 month. Crescent
Type 1
Goodpasture
Linear deposition of IgG in GBM
NC1 domain

Type 2
Immune complex
SLE, IgA, type MPGN

Type 3
Pauci immune

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MPGN
Type 2 DDD, dense deposit disease
 Lamina densa, Bowman's capsule, renal tubules
Recurrence after transportation

C3 glomerular deposition atypical HUS
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Thin basement disease
400 200 nm
Type 4 collagen
Alpha 3,4 subunit defect
Deafness

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Alport syndrome
X linked
Alpha 5 subunit

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15% AR type
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DM nephropathy


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Myeloma
Kappa 多
Light chain
Bence Jones protein
Cast nephropathy

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Amyloid
Beta birefringence
AA, AL type most common
Inflammation AA 未開發
Light chain AL 已開發 lambda

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ATIN, AIN
Chinese herb nephropathy

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Granular kidney
Hypertension
Compensatory hypertrophy

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Rejection
器官經濟學
Endothelial double contour
C4d
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RCC 70%
Clear cell 70%

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UC

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