Dr. Amar C. Al-RikabiDr. Hala Kassouf Kfoury

Objectives 1- Introduction to the renal pathology2- Cystic diseases3- Acute Kidney Injury4- Definitions, Types, Clinical Overview,

Causes5- Pathological findings6- Differential Diagnosis

Lecture -1:

CAPILLARY WALLCAPILLARY WALL

MESANGIUM

GBM

FOOT PROCESSES

BC CL

CL

US

End

Ep

Ep

This paraffin embedded 2µm section illustrates a normal glomerulus with normal vascular pole with minimal periglomerular interstitial fibrosis and surrounding intact tubules

This glomerulus shows only minimal abnormalities by electron microscopy, with rare Vacuoles and blebs in the podocytes.

Bisected kidney shows a less severe form of CRD with multiple cysts and focally a significant degree of disorganization of parenchymal architecture.

Autosomal recessive (infantile) polycystic disease (ARPKD). Elongated streaks represent dilated tubules.

Cut surface of ADPKD showing variable-size, irregular cysts with no recognizable intervening normal parenchyma. Most cysts contain clear fluid and the pelvis is distorted.

Histology of ADPKD shows a single glomerulus alongside several cysts

Late stage of ADPKD showing greatly enlarged renal profiles due to innumerable cysts of varying size replacing the renal parenchyma.

Mayo Clin Proc. 2001;76:67-74

Etiology of ARF

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Prerenal Intrarenal Obstruct Idiopath

Outpatient

Inpatient

The Pathophysiology of ARF

Acute renal failure

Prerenal Postrenal FactitiousIntrarenal

Vascular InterstitialTubularGlomerular

Ischemia

Pigments

Toxins

JASN 1998;9(4):710-718

ACUTE RENAL FAILURE

I. Acute tubular necrosis (ATN)

A. Clinically, rapid deterioration in renal function usually, but not always associated with oliguria.

B. Many different kidney diseases may present with acute renal failure although ATN is the most common cause by far.

C. Conditions associated with ATN1. Shock2. Sepsis3. Incompatible blood transfusions4. Burns5. Crush injury6. Drugs

Acute tubular necrosis (ATN)

• Clinicopathological entity • Destruction of tubular epithelial cell• Clin. acute suppression of renal function

(no urine or below 400 ml/24h)• Most common cause of renal failure

ATN :

Acute tubular necrosis

Kidney in acute tubular necrosis (ATN) showing pale, swollen cortex and congested medulla.

Elongated, stretched out, regenerating proximal tubular lining cells encompass the necrotic epithelium.

Acute Kidney InjuryConclusion :1- Specify the cause of the acute kidney

injury