The Goljan Kidney Powerpoints

8/18/2019 The Goljan Kidney Powerpoints

1/42

KIDNEYLOWER URINARY TRACT

Pages 500-527 RR Path 4th editio


2/42

No!"a#

A$$e!et a!te!io#e E$$e!et a!te!io#e%#o"e!&s

'5

(i#t!ate

)UN*C!!atio

!e"ais'5

A"o&t!ea+so!+edis de,edet

o %(R)UN

(i#te!ed ,a!t#. !ea+so!+ed/igh #e1e#s #ost i si

3!ea# $ai#&!e/C!eatiie

O#. $i#te!ed i ide./ Not!ea+so!+ed o! se!eted/


3/42

A$$e!et a!te!io#e E$$e!et a!te!io#e%#o"e!&s

)UN

C!eatiie

(i#t!ate

)UN*C!

!atio 6'5e/g/ 084

P!e!ea# a9ote"ia

'5

↓Ca!dia o&t,&t

3e/g/ C(

↑Rea+so!,tiod&e to ↓%(R

↓%(R)aed &,+&t !atio!e"aissa"e


4/42

%#o"e!&s

)UN

C!eatiie (i#t!ate

)UN*C!!atio :'5e/g/ 08

Rea# a9ote"iaRea# $ai#&!e

;i %I

: '5

No!ea+so!,tio+ea&se the

,!o


5/42

URINALY;I;Di,sti o#. detets a#+&"i/ ;;A detets a#+&"i = g#o+is3e/g/ )> ,!otei/ I$ si"i#a! !ests i the 2 tests the ,!oteiis a#+&"i/ I$ ;;A is highe! tha the di,sti the g#o+is

3e/g/ #ight hais a!e a#so ,!eset/ Is&!ae o",aies ?i##ass&"e the ,e!so has ide. disease i$ ,!otei&!ia is ,!eset/

Dia+etes "e##it&s &ti# ,!o1e othe!?ise/ (i!st ste, is to o!de!

a +#ood g#&ose/

Di,sti o#. detets aetoe ad AA/It does ot detet -O) 3a#oho#i/

No!"a# $idig i sta!1atio etogei diet ,!ega.


6/42

URINALY;I;

U )ILIRU)IN U U!o+i#ioge

EA - ==

e,atitis == ==

O+st!&ti1e == -

Ne1e! o!"a# i &!ie/ C) ,!eset/ e,atitis ho#estasis

No!"a# o#o! o$ &!ie/ Co#o +ate!ia o1e!to@&gated +i#i!&+i ito &!o+i#ioge 3o#o! o$ stoo# ad

&!ie/

Dis&ssedi #i1e!#et&!es


7/42

URINALY;I;

Detets +8R)Cs ".og#o+i Nit!ite Este!ase

UTI == ==

Ch#a".dia ─ ==

ost &!o,athoges it!ate !ed&e!s

E9."e $!o" e&t!o,hi#s Ca##ed ste!i#e ,.&!ia*stada!d t&!es do otdetet Ch#a".dia/ Ch#a".diais ot a it!ate !ed&e! so

it!ites a!e egati1e/

Este!ase is = +ea&see&t!o,hi#s a!e ,!eset/


8/42

RENAL DY;PLA;IA

>UBENILE POLYCY;TIC

ADULT POLYCY;TIC

C .sti disease/ Ui#ate!a# ,a#,a+#e $#a "ass ie?+o!/

AR/ )i#ate!a# 3io",ati+#e ?ith #i$e/ O#igoh.d!a"ios/Potte!s $aies 3de$o!"atio/

AD/ )i#ate!a#/ C.sts de1e#o, +. 20-25 .!s o#d/ .,e!tesio+e!!. ae&!.s"s 3s&+a!ahoid +#eed/ CR( 40-0 .!s o#d/


9/42

Liea! I(%ood,ast&!es

%!aa! ICsCa dete!"ie o",ositioo$ ICs 3e/g/ Ig% IgA

DNA

Red dots a!e Ig%ati+odies agaist

atige 3?hite dots i

%)/ (eest!a a!e ga,si edothe#ia# e##/

Res,osi+#e $o! !esets

GBM

Endothelial cell

Note podocytes

ICs ha1e di$$e!et si9es ad ha!ge/ La!geICs aot get th!& %) 3+eo"e s&+edo-the#ia# de,osits/ Those ICs that a!e s"a##get th!& %) +&t get t!a,,ed i "esagi&"o! +eeath BEC 3s&+e,ithe#ia# de,osits/

Negati1e ha!ge d&e tohe,a!a s$ate/ Re,e#s

egati1e ha!ge o$ a#+&"i/


10/42

NORAL %LOERULU;


11/42

(&sio o$ ,odo.tes/ A## ases o$ e,h!oti s.d!o"eha1e $&sio o$ the ,odo.tes/

No s,aes +et?ee the toesF

%)

R)C i #&"e


12/42

;&+e,ithe#ia# EDD 3ICs a!e s"a## eo&gh to ,ass th!& the %)/Notie that the %) is a+o1e the EDDG the!e$o!e the EDDs "&st

ha1e ,assed th!& it to +e o the e,ithe#ia# side o$ the %)/

Post-st!e,tooa# %N e"+!ao&s %N

%)

R)C i #&"e


13/42

;&+edothe#ia# EDD/ ICs did ot get th!& the %) +&t

a!e !ight &de!eath the edothe#ia# e## &#e&s/

CAPILLARYLUEN

NUCLEU;

;LE t.,e IB P%N t.,e I

%)


14/42

NEPRITIC ;YNDROE

Ke. $idigs i e,h!iti %N* R)C asts he"at&!ia "i#d to "ode!ate,!otei&!ia/ U!ia#.sis $idigs i s#ide* R)C ast 3#a!ge !ed a!!o?G

d.s"o!,hi R)Cs 3da"agedG si"i#a! to shisto.tes i IAG s"a## !eda!!o?s ad +#a a!!o?s i ,hase ot!astG a,,ea!ae o$ a o!"a#

R)C 3!ed i!#eG &de!stad that it is ot o!"a# to ha1e R)Cs i the&!ie +&t this ?hat the. ?od #oo #ie/


15/42

Di$$&se 3a## g#o"e!i i1o#1ed ,!o#i$e!ati1e 3&"e!o&s &#ei

g#o"e!oe,h!itis 3otais e&t!o,hi#sG a&te i$#a""atio/E


16/42

C!eseti %N 3,!o#i$e!atig,a!ieta# e,ithe#ia# e##sG a!!o?s

C s&+t.,e i ;LE/ ICs DNA-ati-dsDNA 3t.,e III ;R/;&+edothe#ia# EDDs/ isto#og. si"i#a! to ,ost-st!e,tooa# %N

e


17/42

NEPROTIC ;YNDROE

(att. ast ,o#a!i9ed 3a#tese !ossd&e to ho#este!o# ad8o! o1a# $at

+odies 3!ea# t&+a! e##s ?ith

ho#este!o#

De$iitio* ,!otei 6/5g"824 h!s

No i$#a""atio i g#o"e!i.,oa#+&"ie"ia

.,e!ho#este!o#e"ia 3t.,eII h.,e!#i,o,!oteie"iaTh!o"+ogei 3e/g/ !ea#1ei th!o"+osis d&e to↓ATIII J#ost i &!ie

.,oga""ag#o+ie"ia3so"e ases Asites,ittig ede"a 3↓ooti

,!ess&!e $!o"h.,oa#+&"ie"ia


18/42

C a&se o$ e,h!oti s.d!o"e i hi#d!e/ O#. a#+&"i&!ia/T e## .toies a&se a te",o!a!. #oss o$ the egati1e ha!geo$ the %)/ No!"a# g#o"e!i8t&+es/ E o#. sho?s $&sio o$

,odo.tes/ No EDDs/ Negati1e I(/ E


19/42

)B assoiatio d!&gs 20 s.,hi#is/ ;&+e,ithe#ia# EDDs/E,i"e"+!ao&s s,ies 3s&+e,ithe#ia#- a!!o?s/ E si#1e!

stai +e#o?/

igh assoiatio ?ith CB 3#ess o""o i )B d!&gs!.og#o+is/ ;&+edothe#ia# EDDs/ T!a" t!as 3"esagi&"

s,#its %)/ .,e!tesio/ e"at&!ia/ Poo! ,!ogosis/

Thi "e"+!aes/ No i!ease i &#ei/


20/42

DIA)ETIC %LOERULOPATYE$$e!et a!te!io#e h.a#ii9ed $i!st 3+#&e a!!o?G h.a#ie a!te!io#o-

s#e!osis* #eads to↑

%(R ad h.,e!$i#t!atio i@&!. o$ the g#o"e!&s

"ai$ested +. "i!oa#+&"i&!ia/ Noe9."ati g#.os.#atio 3NE% o$the %) "aes it ,e!"ea+#e to ,!otei ad ↑,!ess&!e o g#o"e!a!a,i##a!ies $!o" h.a#ii9atio o$ e$$e!et a!te!io#es a&ses #oss o$

"i&te a"o&ts o$ a#+&"i i the &!ie ?hih is a##ed "i!oa#+&"i&!ia3$i!st #a+ sig o$ dia+eti g#o"e!o,ath./

ACE ihi+ito!s o,e &, e$$e!et a!te!io#e +.↓

ATII 31asoost!ito!/ This ,!e1ets h.,e!$i#t!atio ad #oss o$,!otei/

A$$e!et

a!te!io#e3P%E2G BD

NE% o$e$$e!eta!te!io#e

3ATIIG BC

Noda! g#o"e!os#e!osis

T.,e IB o##age =t!a,,ed ,!oteis


21/42

DIA)ETIC %LOERULOPATY

E$$e!et a!te!io#e3o ATII e$$et/A$$e!et8e$$e!et

a!te!io#es ?i##

e1et&a##. +eh.a#ii9ed i$ st!itg#&ose ot!o# is

ot iitiated/

Noda! g#o"e!os#e!osis*,!otei = t.,e IB o##age


22/42

ACUTE TU)ULAR NECRO;I;

RENAL TU)ULAR CELL CA;T

Ishe"i ATN

P!e!ea# a9ote"ia CC3↓!ea# a!te!. +#ood $#o?Coagatio e!osis

o$ ,!o


23/42

TIN* ACUTE PYELONEPRITI;UUT sigs* $e1e! W)C asts 3iset a!!o?s sho? e&t!o,hi#s

$#a ,ai = LUT sigs 3$!eM&e. d.s&!ia s&,!a,&+i ,ai

Asedig i$etio 3E / 5o#i C* &!eth!a-+#adde!-ide.s 3i$ 1esio&!ete!a# !e$#&< JBUR is ,!esetG

ote that ag#e o$ &!ete! et!. ito ?a## o$ +#adde!

does ot ,!e1et !e$#&


24/42

CRONIC PYELONEPRITI;U-sha,ed sa!s o1e!#.ig +#&t a#.es 3see i IBP/

T&+es at!o,hi 3#oo #ie th.!oid g#ad ad g#o"e!i+eo"e $i+!osed/

)#&t

a#.es


25/42

ACUTE DRU%-INDUCED TIN

ANAL%E;IC NEPROPATY

Ati+iotis N;AID;/ O#ig&!ia $e1e! !ash eosio,hi#ia8&!iaW)C asts/ T.,e I ad IB ;R/ Withd!a? d!&g ad e1e!

&se agai/

Dead#. d&o* aeta"io,he 3(Rs dest!o. !ea# ,a,i##ae as,i!i↓P%E2 Ja 1asodi#ato! i a$$e!et a!te!io#e/ ATII 3a 1asoost!ito!

is ot!o##ig !ea# +#ood $#o?/ Rea# ,a,i##a!. e!osis o&!s 3!igsig o IBP idiates a+set ,a,i##a/ Rea# ,a,i##a!. e!osis a#soo&!s i a&te ,.e#oe,h!itis si#e e## t!ait8disease/


26/42

URATE NEPROPATY

YELOA KIDNEY

Agg!essi1e R< disse"iated ae! a&ses !e#ease ,&!ies

,!od&ig &!ate !.sta#s 3,it&!e o #e$t that +#ost&+es ,!od&ig AR(/ Use a##o,&!io# $i!st to +#o


27/42

CRONIC RENAL (AILURE

Wa


28/42

NEPRO;CLERO;I;Kide. o$ h.,e!tesio 3TN/.a#ie a!te!io#os#e!osis o$a$$e!et8e$$e!et a!te!io#es

3"i!oso,i is the e. $idigad #eads to t&+a! at!o,h.

ad g#o"e!a! $i+!osis/


29/42

BA;CULAR DI;EA;E

a#igat h.,e!tesio

Rea# i$a!tio

;i#e e## e,h!o,ath.

Ra,id ↑)P 32208'0 ?ith ee,ha#o,ath. ad o#ig&!i AR(/.,e!,#asti a!te!io#os#e!osis 3"i!oso,i/ P!ee


30/42

YDRONEPRO;I;

Co",!essio at!o,h.

o!te< ad "ed#a

CC is a stoe ithe &!ete!

)P CC i$ theh.d!oe,h!osis is+i#ate!a#


31/42

UROLITIA;I;.,e!a#i&!ia is the e. "eta+o#i a+o!"a#it. i a#i&"

stoes 3!ea+so!+ too "&h a#i&" $!o" %I t!at Ja+so!,ti1eh.,e!a#i&!ia

Ca#i&" o


32/42

UROLITIA;I;;tagho! a#&s* P!ote&s i$etio ,!od&es &!ease

?hih ,!od&es a""oia ad a a#a#ie , &!ie/ ;toeis o",osed o$ "agesi&"-a""oia-,hos,hate/

U!i aid stoes


33/42

RENAL TUOR;

Rea# e## a!io"a* .e##o? t&"o!?ith #ea! e##s otaiig #i,id

Ca&ses* s"oig APKD

EPO 32o ,o#..the"iaPT-!e#ated ,e,tide

3h.,e!a#e"ia(#a "ass he"at&!ia

I1ades !ea# 1ei 3e.,!ogosti $ato!

L.ti "etastases3,atho#ogi

$!at&!esh.,e!a#e"ia


34/42

RENAL TUOR;WIL; TUORC !ea# t&"o! i hi#d!e

;,o!adi o! AD t.,es 3WA%R* Wi#"s ai!idiageita# a+o!"a#ities !eta!datio

(#a "ass h.,e!tesio 3d&e to i!eased eto,i

,!od&tio o$ !ei


35/42

PENI; ;UAOU; CELL CARCINOA

)LADDER TRAN;ITIONAL8;UAE

La o$ i!&"isio 3s"eg"a PB =8- s"oig

T!asitioa#* s"oig ai#ie d.es .#o,hos,ha"ide

;M&a"o&s* ;5histoso"a he"ato+i&" 3te!"ia# s,ie

Eosio,hi#s a!o&d egg*IgE ati+odies attahed

to egg/ Eosio,hi# IgE!ee,to!s +id to IgE ad!e#ease "a@o! +asi,!otei ?hih i##s egg3t.,e II ;R/


36/42

CRYPTOORCIDI; 3CO

ORCITI;

EPIDIDYITI;

↑

Ris $o! se"io"a i CO testis ad o!"a##. deseded testis/'st "ig!atio I; 2d "ig!atio hC% = ad!oges

Us&a##. &i#ate!a# i "&",s 3$e"a#es de1e#o, oo,ho!itis

;TD i .o&g ,o,atio/ ;!ota# e#e1atio ↓,ai 3P!eh sig/


37/42

BARICOCELE

)ag o$ ?o!"sF

Le$t-sided 3C* s,e!"ati

1ei e",ties ito !ea# 1ei3↑,!ess&!e o s,e!"ati 1ei#eadig to 1a!iose 1eis/Ca +e a&sed +. !ea# e##a!io"a i1adig the !ea#

1ei/

Right-sided* !et!o,e!itoea#$i+!osis/ I$e!io! 1ea a1a

th!o"+osis/

Co""o a&se o$i$e!ti#it. 3e


38/42

TE;TICULAR CANCER

;e"io"a

Pai#ess testia! "ass ae! etastasis to ,a!aao!ti odes/


39/42

PRO;TATE YPERPLA;IADT8est!oge-id&ed/ Pe!i&!eth!a# #oatio/ .,e!,#asia o$

g#ads ad st!o"a/ O+st!&ti1e &!o,ath./ )#adde!di1e!tia/ )i#ate!a# h.d!oe,h!osis/ ↑P;A/ Does ot

t!as$o!" ito ,!ostate ae!/


40/42

PRO;TATE CANCER

Osteo+#asti "etastasis

↑

A#a#ie ,hos,hatase

C "a#e ae!/ DT-id&ed/ Pe!i,he!a# #oatio 3?ithi

!age o$ $ige! i !eta# e


41/42

K#ie$e#te!s s.d!o"e*ote $e"ii9atio

3g.eo"astia $e"a#ehai! dist!i+&tio

No-dis@&tio "eiosis* Y 347h!o"oso"esTesti#es a!e s"a## i si9e 3↓1o#&"e/

;e"ii$e!o&s t&+es a!e $i+!osed→ os,e!"atogeesis 3a9oos,e!"ia ad o ;e!to#ie##s/ A+see o$ ;e!to#i e##s #eads to↓ s.thesis o$ ihi+i 3o!"a# $&tio o$

;e!to#i e##s ad a o!!es,odig ↑s.thesiso$ (; +. the ,it&ita!. g#ad 3ihi+i has a

egati1e $eed+a !e#atioshi, ?ith (;/ ↑(; sti"ates Le.dig e##s

ad adi,ose to↑

s.thesis o$ a!o"atase/↑A!o"atase o1e!ts "ost o$ the testoste!oes.thesi9ed +. Le.dig e##s to est!adio# #eadig

to $e"ii9atio/ I additio ?hat #itt#etestoste!oe is s.thesi9ed +. the Le.dig e##s

aot ite!at ?ith ad!oge !ee,to!s3!ee,to! !esistae ?hih a#so ot!i+&testo $e"ii9atio/

↓Ihi+i → ↑(; → ↑a!o"atase/ ↑A!o"atase→ ↑o1e!sio o$ testoste!oe to est!adio#/↓Testoste!oe a&ses ↑ ,it&ita!. s.thesis o$

L/

Pages '4-'44

;R ihe!itae* "a#e ,se&dohe!"a,h!odite 3geot.,e is


42/42

Ad!oge isesiti1it.s.d!o"e 3AI;G

;R ihe!itae "a#e ,se&dohe!"a,h!odite 3geot.,e is"a#e +&t ,heot.,e is $e"a#e/ I AI; ad!oge

!ee,to!s a!e a+set o! o-$&tioa#/ Testi#es a!e,!eset 3ig&ia# a!ea o! a+do"ia# a1it./

No!"a# "a#e $et&s de1e#o,"et* No!"a#

testoste!oe 3T $&tio is to o1e!t "esoe,h!ist!&t&!es ito aesso!. st!&t&!es 3se"ia# 1esi#ese,idid."is 1as de$e!es/ No!"a# DT $&tio is to

o1e!t $e"a#e a,,ea!ig st!&t&!es ito "a#est!&t&!es/ The #ito!is is o1e!ted ito a ,eis ad#a+ia a!e o1e!ted ito a s!ot&"/ DT a#so de1e#o,sthe ,!ostate g#ad/ #e!ia ihi+ito! s&+stae 3I;is s.thesi9ed +. ;e!to#i e##s ad a&ses a,o,tosis o$#e!ia st!&t&!es ?hih i a $e"a#e $et&s ,!od&e$a##o,ia t&+es &te!&s e!1i

The Goljan Kidney Powerpoints

Documents

Transcript of The Goljan Kidney Powerpoints