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Renal
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Renal

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  1. Renal Pathology

  2. Renal Pathology Outline • Introduction • Glomerular diseases • Tubular and interstitial diseases • Diseases involving blood vessels • Cystic diseases • Tumors

  3. Renal Pathology Outline • Introduction

  4. 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

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

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

  7. Renal Pathology Outline • Introductory stuff • Glomerular diseases

  8. Normal glomerulus

  9. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome • Minimal change disease • Focal segmental glomerulosclerosis • Membranous nephropathy • Nephritic syndrome • Postinfectious GN • IgA nephropathy

  10. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome

  11. Symptoms of Nephrotic Syndrome • Massive proteinuria • Hypoalbuminemia • Edema • Hyperlipidemia, lipiduria

  12. Causes of Nephrotic Syndrome • Adults: systemic disease (diabetes) • Children: minimal change disease • Characterized by loss of foot processes

  13. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome • Minimal change disease

  14. Minimal Change Disease • #1 cause of nephrotic syndrome in children • Loss of foot processes • Pathogenesis unknown • Good prognosis Things You Must Know

  15. Minimal change disease

  16. Normal glomerulus

  17. Minimal change disease

  18. Minimal change disease

  19. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome • Minimal change disease • Focal segmental glomerulosclerosis

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

  21. Focal segmental glomerulosclerosis

  22. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome • Minimal change disease • Focal segmental glomerulosclerosis • Membranous nephropathy

  23. Membranous Nephropathy • Autoimmune reaction against unknown renal antigen • Immune complexes • Thickened GBM • Subepithelial deposits/spikes Things You Must Know

  24. Membranous nephropathy

  25. Membranous nephropathy

  26. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome • Minimal change disease • Focal segmental glomerulosclerosis • Membranous nephropathy • Nephritic syndrome

  27. Symptoms of Nephritic Syndrome • Hematuria • Oliguria, azotemia • Hypertension

  28. Causes of Nephritic Syndrome • Post-infectious GN, IgA nephropathy • Immunologically-mediated • Characterized by proliferative changes and inflammation

  29. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome • Minimal change disease • Focal segmental glomerulosclerosis • Membranous nephropathy • Nephritic syndrome • Postinfectious GN

  30. Post-Infectious Glomerulonephritis • Child after strep throat • Immune complexes • Hypercellular glomeruli • Subepithelial humps Things You Must Know

  31. Post-Infectious Glomerulonephritis “Sore throat, face bloat, pee coke”

  32. Post-infectious glomerulonephritis

  33. Post-infectious glomerulonephritis

  34. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome • Minimal change disease • Focal segmental glomerulosclerosis • Membranous nephropathy • Nephritic syndrome • Postinfectious GN • IgA nephropathy

  35. IgA Nephropathy • Common! • Child with hematuria after URI • IgA in mesangium • Variable prognosis Things You Must Know

  36. IgA nephropathy

  37. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Tubular and interstitial diseases • Inflammatory lesions • pyelonephritis • drug-induced interstitial nephritis • Toxic/ischemic lesions • Acute tubular necrosis

  38. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Tubular and interstitial diseases • Inflammatory lesions • pyelonephritis

  39. Pyelonephritis • Invasive kidney infection • Usually ascends from UTI • Fever, flank pain • Organisms: E. coli, Proteus Things You Must Know

  40. Acute pyelonephritis with abscesses

  41. Acute pyelonephritis

  42. Acute pyelonephritis

  43. Cellular cast

  44. Urinary Tract Infection • Women, elderly • Patients with catheters or malformations • Dysuria, frequency • Organisms: E. coli, Proteus