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Renal Pathology
Introduction:150gm: each kidney1700 liters of blood filtered 180 L of G. filtrate 1.5 L of urine / day.Kidney is a retro-peritoneal organBlood supply: Renal Artery & VeinOne half of kidney is sufficient reservekidney function: Filtration, Excretion, Secretion, Hormone synthesis.
Kidney Location:
Kidney Anatomy:
Renal Pathology OutlineGlomerular diseases: GlomerulonephritisTubular diseases: Acute tubular necrosis interstitial diseases: PyelonephritisDiseases involving blood vessels: NephrosclerosisCystic diseasesTumors
Clinical Syndromes:Nephritic syndrome.Oliguria, Haematuria, Proteinuria, Oedema.Nephrotic syndrome.Gross proteinuria, hyperlipidemia, Acute renal failure Oliguria, loss of Kidney function - within weeksChronic renal failure.Over months and years - Uremia
IntroductionFunctions of the kidney:excretion of waste productsregulation of water/saltmaintenance of acid/base balancesecretion of hormonesDiseases of the kidneyglomerulitubulesinterstitiumvessels
Azotemia: BUN, creatinine Uremia: azotemia + more problems Acute renal failure: oliguria Chronic renal failure: prolonged uremia
Abnormal findings
Glomerular diseasesNephrotic syndromeMinimal change diseaseFocal segmental glomerulosclerosisMembranous nephropathyNephritic syndromePost-infectious GNIgA (immune) nephropathy
Nephrotic SyndromeMassive proteinuriaHypoalbuminemiaEdemaHyperlipidemia
Adults: systemic disease (diabetes)Children: minimal change diseaseCharacterized by loss of foot processesGood prognosisCauses
Minimal change disease
Minimal change diseaseNormal glumerular structure
Normal glomerulusMinimal change disease
Focal Segmental GlomerulosclerosisPrimary or secondarySome (focal) glomeruli show partial (segmental) hyalinizationUnknown pathogenesisPoor prognosis
Focal segmental glomerulosclerosis
Membranous GlomerulonephritisAutoimmune reaction against unknown renal antigenImmune complexesThickened GBMSubepithelial deposits
Membranous glomerulonephritis
Nephritic SyndromeHematuriaOliguria, azotemiaHypertension
Post-infectious GN, IgA nephropathyImmunologically-mediatedCharacterized by proliferative changes and inflammationCauses
Post-Infectious GlomerulonephritisChild after streptococcal throat infectionImmune complexesHypercellular glomeruliSubepithelial humps
Post-infectious glomerulonephritis
IgA NephropathyCommon!Child with hematuria after (URI) Upper Respiratory Infection IgA in mesangiumVariable prognosis
IgA nephropathy
Tubular and interstitial diseasesInflammatory lesionspyelonephritis
PyelonephritisInvasive kidney infectionUsually ascends from UTIFever, flank painOrganisms: E. coli, Proteus
Women, elderlyPatients with catheters or mal-formationsDysuria, frequencyOrganisms: E. coli, ProteusUrinary Tract Infection
Acute pyelonephritis with abscesses
Pyelonephritis
Cellular cast
Chronic pyelonephritis
Drug-Induced Interstitial NephritisAntibiotics, NSAIDSIgE and T-cell-mediated immune reactionFever, eosinophilia, hematuriaPatient usually recoversAnalgesic nephritis is different (bad)
Drug-induced interstitial nephritis
Acute Tubular NecrosisThe most common cause of ARF!Reversible tubular injuryMany causes: ischemic (shock), toxic (drugs)Most patients recover
Acute tubular necrosis
Benign NephrosclerosisFound in patients with benign hypertensionHyaline thickening of arterial wallsLeads to mild functional impairmentRarely fatal
Benign nephrosclerosis
Malignant nephrosclerosisArises in malignant hypertensionHyperplastic vesselsIschemia of kidneyMedical emergency
5% of cases of hypertensionSuper-high blood pressure, encephalopathy, heart abnormalitiesFirst sign often headache, scotomasDecreased blood flow to kidney leads to increased renin, which leads to increased BP!5y survival: 50%Malignant Hypertension
Malignant hypertension
Adult Polycystic Kidney DiseaseAutosomal dominantHuge kidneys full of cystsUsually no symptoms until 30 yearsAssociated with brain aneurysms.
Adult polycystic kidney disease
Childhood Polycystic Kidney DiseaseAutosomal recessiveNumerous small cortical cystsAssociated with liver cystsPatients often die in infancy
Childhood polycystic kidney disease
Medullary Cystic Kidney DiseaseChronic renal failure in childrenComplex inheritanceKidneys contracted, with many cystsProgresses to end-stage renal disease
TumorsRenal cell carcinomaBladder carcinoma
Renal Cell CarcinomaDerived from tubular epitheliumSmoking, hypertension, cadmium exposureHematuria, abdominal mass, flank painIf metastatic, 5y survival = 5%
Renal cell carcinoma
Bladder CarcinomaDerived from transitional epitheliumPresent with painless hematuriaPrognosis depends on grade and depth of invasionOverall 5y survival = 50%
Bladder carcinoma
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