Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases...

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Rena l Patholo gy

Transcript of Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases...

Page 1: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

RenalPathology

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

• Introduction

• Glomerular diseases

• Tubular and interstitial diseases

• Diseases involving blood vessels

• Cystic diseases

• Tumors

Renal Pathology Outline

Page 3: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introduction

Renal Pathology Outline

Page 4: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.
Page 5: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• 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

Introduction

Page 6: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

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

Introduction

Page 7: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Hematuria• Oliguria• Azotemia• Hypertension

Nephritic syndrome

• Massive proteinuria• Hypoalbuminemia• Edema• Hyperlipidemia/-uria

Nephrotic syndrome

Introductory Stuff

Page 8: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.
Page 9: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.
Page 10: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.
Page 11: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases

Renal Pathology Outline

Page 12: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.
Page 13: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Normal glomerulus

Page 14: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases• Nephrotic syndrome

• Minimal change disease• Focal segmental glomerulosclerosis• Membranous nephropathy

• Nephritic syndrome• Postinfectious GN• IgA nephropathy

Renal Pathology Outline

Page 15: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases• Nephrotic syndrome

Renal Pathology Outline

Page 16: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Massive proteinuria

• Hypoalbuminemia

• Edema

• Hyperlipidemia, lipiduria

Symptoms of Nephrotic Syndrome

Page 17: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Adults: systemic disease (diabetes)

• Children: minimal change disease

• Characterized by loss of foot processes

Causes of Nephrotic Syndrome

Page 18: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases• Nephrotic syndrome

• Minimal change disease

Renal Pathology Outline

Page 19: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• #1 cause of nephrotic syndrome in children

• Loss of foot processes

• Pathogenesis unknown

• Good prognosis

Minimal Change Disease

Things You Must Know

Page 20: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Minimal change disease

Page 21: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Normal glomerulus

Page 22: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Minimal change disease

Page 23: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Minimal change disease

Page 24: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases• Nephrotic syndrome

• Minimal change disease• Focal segmental glomerulosclerosis

Renal Pathology Outline

Page 25: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Primary or secondary

• Some (focal) glomeruli show partial (segmental) hyalinization

• Unknown pathogenesis

• Poor prognosis

Focal Segmental Glomerulosclerosis

Things You Must Know

Page 26: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Focal segmental glomerulosclerosis

Page 27: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases• Nephrotic syndrome

• Minimal change disease• Focal segmental glomerulosclerosis• Membranous nephropathy

Renal Pathology Outline

Page 28: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Autoimmune reaction against unknown renal antigen

• Immune complexes

• Thickened GBM

• Subepithelial deposits/spikes

Membranous Nephropathy

Things You Must Know

Page 29: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Membranous nephropathy

Page 30: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Membranous nephropathy

Page 31: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases• Nephrotic syndrome

• Minimal change disease• Focal segmental glomerulosclerosis• Membranous nephropathy

• Nephritic syndrome

Renal Pathology Outline

Page 32: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Hematuria

• Oliguria, azotemia

• Hypertension

Symptoms of Nephritic Syndrome

Page 33: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Post-infectious GN, IgA nephropathy

• Immunologically-mediated

• Characterized by proliferative changes and inflammation

Causes of Nephritic Syndrome

Page 34: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases• Nephrotic syndrome

• Minimal change disease• Focal segmental glomerulosclerosis• Membranous nephropathy

• Nephritic syndrome• Postinfectious GN

Renal Pathology Outline

Page 35: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Child after strep throat

• Immune complexes

• Hypercellular glomeruli

• Subepithelial humps

Post-Infectious Glomerulonephritis

Things You Must Know

Page 36: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

“Sore throat, face bloat, pee coke”

Post-Infectious Glomerulonephritis

Page 37: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Post-infectious glomerulonephritis

Page 38: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Post-infectious glomerulonephritis

Page 39: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases• Nephrotic syndrome

• Minimal change disease• Focal segmental glomerulosclerosis• Membranous nephropathy

• Nephritic syndrome• Postinfectious GN• IgA nephropathy

Renal Pathology Outline

Page 40: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Common!

• Child with hematuria after URI

• IgA in mesangium

• Variable prognosis

IgA Nephropathy

Things You Must Know

Page 41: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

IgA nephropathy

Page 42: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases

• Tubular and interstitial diseases• Inflammatory lesions

• pyelonephritis• drug-induced interstitial nephritis

• Toxic/ischemic lesions• Acute tubular necrosis

Renal Pathology Outline

Page 43: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases

• Tubular and interstitial diseases• Inflammatory lesions

• pyelonephritis

Renal Pathology Outline

Page 44: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Invasive kidney infection

• Usually ascends from UTI

• Fever, flank pain

• Organisms: E. coli, Proteus

Pyelonephritis

Things You Must Know

Page 45: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Acute pyelonephritis with abscesses

Page 46: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Acute pyelonephritis

Page 47: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Acute pyelonephritis

Page 48: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Cellular cast

Page 49: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.
Page 50: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Women, elderly

• Patients with catheters or malformations

• Dysuria, frequency

• Organisms: E. coli, Proteus

Urinary Tract Infection

Page 51: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

E. coli

uncomplicated complicated

UTI: Common Bugs

Page 52: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Urinary catheter colonized by Proteus

Page 53: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Chronic pyelonephritis

Page 54: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases

• Tubular and interstitial diseases• Inflammatory lesions

• pyelonephritis• drug-induced interstitial nephritis

Renal Pathology Outline

Page 55: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Antibiotics, NSAIDS

• IgE and T-cell-mediated immune reaction

• Fever, eosinophilia, hematuria

• Patient usually recovers

• Analgesic nephritis is different (bad)

Drug-Induced Interstitial Nephritis

Things You Must Know

Page 56: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Drug-induced interstitial nephritis

Page 57: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases

• Tubular and interstitial diseases• Inflammatory lesions

• pyelonephritis• drug-induced interstitial nephritis

• Toxic/ischemic lesions• Acute tubular necrosis

Renal Pathology Outline

Page 58: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• The most common cause of ARF!

• Reversible tubular injury

• Many causes: ischemic (shock), toxic (drugs)

• Most patients recover

Acute Tubular Necrosis

Things You Must Know

Page 59: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Acute tubular necrosis

Page 60: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Acute tubular necrosis

Page 61: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases

• Tubular and interstitial diseases

• Diseases involving blood vessels• Benign nephrosclerosis

• Malignant nephrosclerosis

Renal Pathology Outline

Page 62: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Found in patients with benign hypertension

• Hyaline thickening of arterial walls

• Leads to mild functional impairment

• Rarely fatal

Benign Nephrosclerosis

Things You Must Know

Page 63: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Benign nephrosclerosis

Page 64: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Arises in malignant hypertension

• Hyperplastic vessels

• Ischemia of kidney

• Medical emergency

Malignant Nephrosclerosis

Things You Must Know

Page 65: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• 5% of cases of hypertension

• Super-high blood pressure, encephalopathy, heart abnormalities

• First sign often headache, scotomas

• Decreased blood flow to kidney leads to increased renin, which leads to increased BP!

• 5y survival: 50%

Malignant Hypertension

Page 66: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Malignant nephrosclerosis

Page 67: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Malignant nephrosclerosis

Page 68: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases

• Tubular and interstitial diseases

• Diseases involving blood vessels

• Cystic diseases• Adult polycystic kidney disease

• Childhood polycystic kidney disease

Renal Pathology Outline

Page 69: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Autosomal dominant

• Huge kidneys full of cysts

• Usually no symptoms until 30s

• Associated with brain aneurysms

Adult Polycystic Kidney Disease

Things You Must Know

Page 70: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Adult polycystic kidney disease

Page 71: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Autosomal recessive

• Numerous small cortical cysts

• Associated with liver cysts

• Patients often die in infancy

Childhood Polycystic Kidney Disease

Things You Must Know

Page 72: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Childhood polycystic kidney disease

Page 73: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases

• Tubular and interstitial diseases

• Diseases involving blood vessels

• Cystic diseases

• Tumors• Renal cell carcinoma

• Bladder carcinoma

Renal Pathology Outline

Page 74: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Derived from tubular epithelium

• Smoking, hypertension, cadmium exposure

• Hematuria, abdominal mass, flank pain

• If metastatic, 5y survival = 5%

Renal Cell Carcinoma

Things You Must Know

Page 75: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Renal cell carcinoma

Page 76: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Renal cell carcinoma

Page 77: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Renal cell carcinoma

Page 78: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Derived from transitional epithelium

• Presents with painless hematuria

• Prognosis depends on grade and depth of invasion

• Overall 5y survival = 50%

Bladder Carcinoma

Things You Must Know

Page 79: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.
Page 80: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

Bladder carcinoma

Page 81: Renal Pathology. Introduction Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology.

• Introductory stuff

• Glomerular diseases

• Tubular and interstitial diseases

• Diseases involving blood vessels

• Cystic diseases

• Tumors

Renal Pathology Outline