Renal patology is the best renal, glomerular

Renal patology is the best

1. Renal Pathology

2. Introduction:
•150gm: each kidney
•1700 liters of blood filtered  180 L of G. filtrate 
1.5 L of urine / day.
•Kidney is a retro-peritoneal organ
•Blood supply: Renal Artery & Vein
•One half of kidney is sufficient – reserve
•kidney function: Filtration, Excretion, Secretion,
Hormone synthesis.

3. Kidney
Location:

4. Kidney Anatomy:

5. Renal Pathology Outline
•Glomerular diseases: Glomerulonephritis
•Tubular diseases: Acute tubular necrosis
• interstitial diseases: Pyelonephritis
•Diseases involving blood vessels: Nephrosclerosis
•Cystic diseases
•Tumors

6. Clinical Syndromes:
•Nephritic syndrome.
–Oliguria, Haematuria, Proteinuria, Oedema.
•Nephrotic syndrome.
–Gross proteinuria, hyperlipidemia,
•Acute renal failure
–Oliguria, loss of Kidney function - within weeks
•Chronic renal failure.
–Over months and years - Uremia

7. Introduction
•Functions of the kidney:
–excretion of waste products
–regulation of water/salt
–maintenance of acid/base balance
–secretion of hormones
•Diseases of the kidney
–glomeruli
–tubules
–interstitium
–vessels

9. • Azotemia:  BUN, creatinine
• Uremia: azotemia + more problems
• Acute renal failure: oliguria
• Chronic renal failure: prolonged uremia
Abnormal findings

10. • Hematuria
• Oliguria
• Azotemia
• Hypertension
Nephritic syndrome
• Massive proteinuria
• Hypoalbuminemia
• Edema
• Hyperlipidemia/-uria
Nephrotic syndrome

14. Glomerular diseases
–Nephrotic syndrome
•Minimal change disease
•Focal segmental glomerulosclerosis
•Membranous nephropathy
–Nephritic syndrome
•Post-infectious GN
•IgA (immune) nephropathy

15. Nephrotic Syndrome
•Massive proteinuria
•Hypoalbuminemia
•Edema
•Hyperlipidemia

16. •Adults: systemic disease (diabetes)
•Children: minimal change disease
•Characterized by loss of foot processes
•Good prognosis
Causes

17. Minimal change disease

18. Minimal change disease Normal glumerular structure

19. Normal glomerulusMinimal change disease

20. Focal Segmental Glomerulosclerosis
•Primary or secondary
•Some (focal) glomeruli show partial
(segmental) hyalinization
•Unknown pathogenesis
•Poor prognosis

21. Focal segmental glomerulosclerosis

22. Membranous Glomerulonephritis
•Autoimmune reaction against unknown renal antigen
•Immune complexes
•Thickened GBM
•Subepithelial deposits

23. Membranous glomerulonephritis

24. Nephritic Syndrome
•Hematuria
•Oliguria, azotemia
•Hypertension

25. •Post-infectious GN, IgA nephropathy
•Immunologically-mediated
•Characterized by proliferative changes and
inflammation
Causes

26. Post-Infectious Glomerulonephritis
•Child after streptococcal throat infection
•Immune complexes
•Hypercellular glomeruli
•Subepithelial humps

27. Post-infectious
glomerulonephritis

28. IgA Nephropathy
•Common!
•Child with hematuria after (URI) Upper
Respiratory Infection
•IgA in mesangium
•Variable prognosis

29. IgA nephropathy

30. •Tubular and interstitial diseases
–Inflammatory lesions
•pyelonephritis

31. Pyelonephritis
•Invasive kidney infection
•Usually ascends from UTI
•Fever, flank pain
•Organisms: E. coli, Proteus

32. •Women, elderly
•Patients with catheters or mal-formations
•Dysuria, frequency
•Organisms: E. coli, Proteus
Urinary Tract Infection

33. Acute pyelonephritis with abscesses

34. Pyelonephritis

35. Cellular cast

37. Chronic pyelonephritis

38. Drug-Induced Interstitial Nephritis
•Antibiotics, NSAIDS
•IgE and T-cell-mediated immune reaction
•Fever, eosinophilia, hematuria
•Patient usually recovers
•Analgesic nephritis is different (bad)

39. Drug-induced interstitial nephritis

40. Acute Tubular Necrosis
•The most common cause of ARF!
•Reversible tubular injury
•Many causes: ischemic (shock), toxic (drugs)
•Most patients recover

41. Acute tubular
necrosis

42. Benign Nephrosclerosis
•Found in patients with benign hypertension
•Hyaline thickening of arterial walls
•Leads to mild functional impairment
•Rarely fatal

43. Benign nephrosclerosis

44. Malignant nephrosclerosis
•Arises in malignant hypertension
•Hyperplastic vessels
•Ischemia of kidney
•Medical emergency

45. •5% of cases of hypertension
•Super-high blood pressure, encephalopathy, heart
abnormalities
•First sign often headache, scotomas
•Decreased blood flow to kidney leads to increased
renin, which leads to increased BP!
•5y survival: 50%
Malignant Hypertension

46. Malignant
hypertension

47. Adult Polycystic Kidney Disease
•Autosomal dominant
•Huge kidneys full of cysts
•Usually no symptoms until 30 years
•Associated with brain aneurysms.

48. Adult polycystic kidney disease

49. Childhood Polycystic Kidney Disease
•Autosomal recessive
•Numerous small cortical cysts
•Associated with liver cysts
•Patients often die in infancy

50. Childhood polycystic kidney disease

51. Medullary Cystic Kidney Disease
•Chronic renal failure in children
•Complex inheritance
•Kidneys contracted, with many cysts
•Progresses to end-stage renal disease

52. •Tumors
–Renal cell carcinoma
–Bladder carcinoma

53. Renal Cell Carcinoma
•Derived from tubular epithelium
•Smoking, hypertension, cadmium exposure
•Hematuria, abdominal mass, flank pain
•If metastatic, 5y survival = 5%

54. Renal cell carcinoma

55. Bladder Carcinoma
•Derived from transitional epithelium
•Present with painless hematuria
•Prognosis depends on grade and depth of invasion
•Overall 5y survival = 50%

57. Bladder carcinoma