43 renal pathology
-
Upload
dang-thanh-tuan -
Category
Documents
-
view
1.316 -
download
2
Transcript of 43 renal pathology
![Page 1: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/1.jpg)
TUBULOINTERSTITIAL DISEASESTerminology
Tubulointerstitial nephritis:• Primary - Inflammation limited to tubules & with uninvolved
or minimally involved glomeruli/vessels. – Acute - Sudden onset & rapid decline in renal function
associated with interstitial edema – Chronic - Protracted onset and slow decline in renal
function associated with interstitial fibrosis• Secondary - Tubulointerstitial inflammation associated
with primary glomerular/vascular diseases
• Infectious – Tubulointerstitial inflammation associated with presence of live microorganism
• Idiopathic – Tubulointerstitial nephritis where etiological agents or causes are not known
• Reactive – Tubulointerstitial inflammation from the effects of systemic inflammation. Kidney is sterile.
![Page 2: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/2.jpg)
TUBULOINTERSTITIAL DISEASETerminology ( cont.)
Urinary tract infection • colonization of excretory system by live microorganism
• Pyelonephritis: tubulointerstitial nephritis with pelvis and calyceal involvement
– Acute - usually suppurative inflammation involving pelvi-calyceal system and parenchyma
– Chronic - involvement of pelvi-calyceal system and parenchyma with prominent
scarring
![Page 3: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/3.jpg)
Tubulointerstitial nephritisCauses
Infections: (1) Reactive (2) Infectious Drug reaction Obstruction:
(1) with infection: pyelonephritis / pyonephrosis (2) without infection : hydronephrosis
Non-obstructive : vesicoureteral reflux Immune mediated :
(1) with anti TBM antibodies, can be 10 or 20 (2) with IC deposition which can be 10 or 20
![Page 4: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/4.jpg)
Tubulointerstitial nephritisPathogenetic mechanisms
Antibody mediated• Anti-TBM-antibody disease• Immune-complex disease
T-cell mediated Associated with infections
• Reactive• Infectious
![Page 5: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/5.jpg)
Tubuluinterstitial nephritis
Primary anti-TBM-antibody nephritis• IgG antibodies directed against tubular basement
membrane
• Linear staining on immunofluorescence microscopy
• Edema and mononuclear cells in interstitium
• Glomeruli and blood vessels are unremarkable
Secondary anti-TBM-antibody disease• 20 to 10 glomerulonephritidies, allograft nephropathy
![Page 6: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/6.jpg)
Tubulointerstitial nephritis with immune complexes
Primary immune complex disease • granular staining on IF microscopy on tubular
basement membrane• Primary – Rare• Secondary – Usually associated with primary
glomerulonephritidies involving TBM and interstitium– e.g SLE, MPGN, Membranous GN etc.
![Page 7: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/7.jpg)
Cell-mediated mechanism
Delayed-type hypersensitivity reaction• Activated CD4+ T and monocyte / macrophage
cells releases cytokines which modulates inflammatory reactions and fibrogenesis
• Cytotoxic T-cell injury in which CD4+ T and CD8+ T play important role
![Page 8: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/8.jpg)
Pathology of primary IN
bilaterally symmetrical enlargement of kidney
edema inflammatory cells in interstitium tubular change including tubulitis, breaks in
TBM, necrosis of tubular epithelial cells etc.
![Page 9: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/9.jpg)
Pathology of renal failure
acute
chronic
![Page 10: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/10.jpg)
Acute renal failure (ARF)
Rapid deterioration of renal function in a relatively short period of time
Sudden inability to maintain normal fluid and electrolyte homeostasis
Marked decrease in renal output May be of glomerular, tubular, interstitial or
vascular origin
![Page 11: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/11.jpg)
Causes of ARF
acute tubular necrosis infarction & cortical necrosis organic diseases of renal vessels severe forms of glomerulonephritis severe infection acute tubulointerstitial nephritis outflow obstruction (post-renal) impairment of blood flow (pre-renal)
![Page 12: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/12.jpg)
Acute tubular necrosis (ATN)
commonest cause of acute renal failure develops due to :
• direct poisoning of tubules (nephrotoxic lesions)
• renal ischemia (tubulorrhexic lesions)
![Page 13: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/13.jpg)
Acute tubular necrosisEtiology & Pathogenesis
Ischemic in origin (Tubulorrhexic lesion)
Prolonged ischemia due to:
Shock: postoperative, intra-operative, post-traumatic, septic, hypotensive
Hemorrhage: postpartum hemorrhage, abruptio placentae
Other: severe burns, transfusion accidents, dehydration, heat stroke, crushing injuries, non-traumatic
rhabdomyolysis, paroxysmal hemoglobinuria etc.
![Page 14: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/14.jpg)
Acute tubular necrosisEtiology and Pathogenesis
Direct effects of toxins (Nephrotoxic lesion)
Therapeutic agents :• Antibiotics : Aminoglycosides, NSAIDs,
chemotherapeutic agents, etc.• Heavy metals: mercury, lead, gold etc.• Radiocontrast agents• Multiple bee stings, scorpion bites etc.
![Page 15: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/15.jpg)
Gross pathology
bilaterally enlarged & swollen kidney due to edema
Cut surface bulges and has a flabby consistency
widened & pale cortex dark & congested medulla
![Page 16: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/16.jpg)
![Page 17: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/17.jpg)
![Page 18: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/18.jpg)
Light microscopy
dilated lumen with flattened epithelial cells Greatest change in proximal tubules, varies in two
forms loss of brush borders- proximal tubules evidence of regeneration of epithelial cells hyaline, granular and pigmented casts interstitial edema & inflammation Intra-vascular collection of nucleated red blood
cells
![Page 19: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/19.jpg)
![Page 20: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/20.jpg)
ATN- Prognosis
depends upon underlying cause, over all mortality rate 50%
post-traumatic (62%), post-operative (56%), medical (46 %), obstetric (17 %)
Higher in older debilitated pts. & in pts.with multiple organ disease
good for uncomplicated and younger patients
![Page 21: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/21.jpg)
Chronic renal failure Occurs in all cases of end-stage renal disease of
whatever etiology GFR falls below 20% of normal End result of all chronic renal disease which can
be glomerular, tubulointerstitial or vascular in origin
Characterized by prolonged signs and symptoms of uremia
Is a major cause of death in renal disease
![Page 22: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/22.jpg)
Chronic renal failure
Systemic (visceral) manifestations• Enlarged heart & pericarditis• Uremic pneumonitis & pleuritis• Uremic colitis• Uremic encephalopathy• Hypoplastic anemia
![Page 23: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/23.jpg)
TUBULO-INTERSTITIAL DISEASE
Urinary tract infection • colonization of excretory system by live microorganism• Most caused by gram negative enteric organism• Most common form of renal involvement is:
– Pyelonephritis: bacterial infection of the kidney that affects parenchyma, calyces and pelvis
• Acute - usually suppurative inflammation involving – pelvi-calyceal system and parenchyma
• Chronic - involvement pelvi-calyceal system and parenchyma with prominent
scarring
![Page 24: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/24.jpg)
Pyelonephritis
• Acute: usually suppurative, often associated
(1) with / without obstruction
(2) ascending infection through vesicoureteral reflux (3) from hematogenous dissemination.
• Chronic: inflammation with prominent scarring; may be
(1) obstructive with recurrent infection
(2) non-obstructive with vesicoureteral reflux → reflux nephropathy
![Page 25: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/25.jpg)
Acute PyelonephritisPredisposing factors
Urinary obstruction: congenital or acquired Instrumentation of urinary tract Vesicoureteral reflux Pregnancy: 4-6% develops bacteriuria Gender and age Preexisting renal lesions Diabetes mellitus, immunosuppression &
immunodeficiency
![Page 26: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/26.jpg)
Acute pyelonephritis route of invasion :
• via blood stream• ascending route
obstructive non-obstructive
role of vesicoureteral reflux and infected urine
![Page 27: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/27.jpg)
![Page 28: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/28.jpg)
![Page 29: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/29.jpg)
![Page 30: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/30.jpg)
![Page 31: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/31.jpg)
![Page 32: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/32.jpg)
Chronic pyelonephritis
It is a chronic tubulointerstitial inflammation involving renal parenchyma, pelvis and calyces associated with scarring
non-obstructive• reflux nephropathy
obstructive
![Page 33: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/33.jpg)
![Page 34: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/34.jpg)
![Page 35: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/35.jpg)
![Page 36: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/36.jpg)
![Page 37: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/37.jpg)
![Page 38: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/38.jpg)
![Page 39: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/39.jpg)
![Page 40: 43 renal pathology](https://reader035.fdocuments.net/reader035/viewer/2022062312/5565d84fd8b42ae8258b4ce0/html5/thumbnails/40.jpg)