Home >Documents >Kidney pathology 2010.1 Tubular & interstitial diseases.

Kidney pathology 2010.1 Tubular & interstitial diseases.

Date post:25-Dec-2015
Category:
View:213 times
Download:1 times
Share this document with a friend
Transcript:
  • Slide 1
  • Kidney pathology 2010.1 Tubular & interstitial diseases
  • Slide 2
  • Kidney - cut surface Outer cortex (Co) Inner medulla composed of pyramids * Cortical columns of Bertini (B) between pyramids* Urine first collects in calyces, pelvis * Co B Calyx * Pelvis
  • Slide 3
  • Malpighi and Malpighian corpuscles (glomeruli)
  • Slide 4
  • Glomerular structure Arterioles Capillaries Mesangium (between capillaries) Urinary space surrounds glomerulus within Bowmans capsule Urin sp -> prox tubule
  • Slide 5
  • Normal renal tubules
  • Slide 6
  • Acute pyelonephritis Most severe end of spectrum of UTI Acute bacterial inflammation of kidney E coli, Proteus, Enterobacter, Klebsiella Abscesses in cortex, medulla Polymorphs in tubules; glomeruli spared (CMV, polyoma virus in immunocompromised)
  • Slide 7
  • Acute pyelonephritis
  • Slide 8
  • Slide 9
  • Acute pyelonephritis - clinical M < 1yr and over 40 yrs; F 1 - 40 yrs Sudden onset tenderness in costo-phrenic angle Temp, rigors, cystitis Most resolve quickly May recur, become chronic Complications
  • Slide 10
  • Pathogenesis of acute pyelonephritis (Haematogenous spread) Bacterial adhesins, colonisation, ascending infection Cystitis Vesico-Ureteric Reflux & Intrarenal Reflux, congenital or acquired VUR: Urine, bacteria -> ureter Inrarenal reflux: Urine enters kidney papillae
  • Slide 11
  • Predisposing factors Short female urethra Obstruction (pregnancy, congenital, stones, tumours, BPH) Bladder dysfunction Diabetes Catheters, cystoscopy, other Vesico-Ureteric Reflux & Intrarenal Reflux If no reflux, infection only in bladder
  • Slide 12
  • Complications of Acute Pyelo Perinephric abscess Pyonephrosis *Papillary necrosis Fibrous scars, chronic pyelonephritis
  • Slide 13
  • Chronic pyelonephritis Scars overlying distended calyces Chronic inflammation and fibrosis involving tubules and interstitium Two types Reflux nephropathy Chronic obstructive pyelonephritis
  • Slide 14
  • Reflux nephropathy Commoner VUR pressure threshold Organisms Refluxing papillae at upper, lower poles Hypertension at 15-25 yrs
  • Slide 15
  • Chronic pyelonephritis (reflux)
  • Slide 16
  • Chronic pyelonephritis - reflux type
  • Slide 17
  • Chronic pyelonephritis, obstructive Older patients Strictures, calculi in ureter, renal pelvis BPH Tumours
  • Slide 18
  • Chronic pyelonephritis - clinical Chronic renal failure, hypertension UTI (but often negative urine cultures) Interstitial fibrosis, tubular atrophy, thyroidization of tubules, thick arteries, FSGS Accounts for 10 - 20% of patients on dialysis Other types of pyelonephritis
  • Slide 19
  • TB (L) & Xanthogranulomatous PN (R)
  • Slide 20
  • Non-bacterial inflammation of renal tubules, interstitium Drugs/toxins: penicillins, rifampicin, NSAIDs.. Immune injury (types I, IV); direct, unknown Fever, oliguria in 50%, rash Micro; inflammatory cells, inc eosinophils Analgesic nephropathy - phenacetin, +/- aspirin, codeine Assoc with glomerular disease e.g. SLE, renal vasculitis Gout, multiple myeloma Renal allograft rejection
  • Slide 21
  • Acute interstitial nephritis
  • Slide 22
  • Eosinophils in drug induced interstitial nephritis
  • Slide 23
  • Acute renal transplant rejection
  • Slide 24
  • Acute renal failure Sudden onset of oliguria (
  • Acute renal failure - pathology Most patients have a microscopic lesion - Acute Tubular Necrosis (necrosis of tubular epithelial cells is a marker of acute loss of renal function) Renal tubular epithelium sensitive to toxins, ischaemia Vasoconstriction -> hypoxia in outer medulla Two types of ATN: ATN due to drugs, toxins - PCT cells (95% survival) ATN due to ischaemia, shock or sepsis - granular casts (20-50% survival)
  • Slide 26
  • Normal tubules (L) and drug-induced ATN* (R) *
  • Slide 27
  • ATN, drug-induced
  • Slide 28
  • ATN due to toxin
  • Slide 29
  • ATN due to Sepsis/Ischaemia
  • Slide 30
  • Interstitial fibrosis and tubular atrophy in chronic renal disease correlate with progressive loss of renal function
  • Slide 31
  • Chronic renal failure Progressive and irreversible loss of renal tissue Chronic GN, chronic PN, hypertensive nephrosclerosis, diabetes, adult type PCKD Symptoms - anaemia, dehydration, nausea, metabolic bone disease, etc Asymptomatic renal insufficiency present prior to this while kidneys intact nephrons compensate Dialysis, transplant or death within 1 year of onset of CRF
Popular Tags:

Click here to load reader

Reader Image
Embed Size (px)
Recommended