Rena
Patholog
ly
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Tubular and interstitial
diseases
Diseases involving blood
vessels
Cystic diseases
Tumors
Renal Pathology Outline
Introductory stuf
Introductory Stuf
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
Introductory Stuf
Azotemia: BUN, creatinine
Uremia: azotemia + more
problems
Acute renal failure: oliguria
Chronic renal failure: prolonged
uremia
Introductory Stuf
Nephrotic syndrome
Nephritic syndrome
Massive proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia/-uria
Hematuria
Oliguria
Azotemia
Hypertension
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Normal glomerulus
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Nephrotic syndrome
Minimal change disease
Focal segmental
glomerulosclerosis
Membranous nephropathy
Nephritic syndrome
Postinfectious GN
IgA nephropathy
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Nephrotic syndrome
Symptoms of Nephrotic
Syndrome
Massive proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia,
lipiduria
Causes of Nephrotic Syndrome
Adults: systemic disease (diabetes)
Children: minimal change disease
Characterized by loss of foot
processes
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Nephrotic syndrome
Minimal change disease
Minimal Change Disease
Things You Must Know
#1 cause of nephrotic syndrome in
children
Loss of foot processes
Pathogenesis unknown
Good prognosis
Minimal change disease
Normal glomerulus
Minimal change disease
Minimal change disease
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Nephrotic syndrome
Minimal change disease
Focal segmental
glomerulosclerosis
Focal Segmental
Glomerulosclerosis
Things You Must Know
Primary or secondary
Some (focal) glomeruli show
partial (segmental)
hyalinization
Unknown pathogenesis
Poor prognosis
Focal segmental glomerulosclerosis
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Nephrotic syndrome
Minimal change disease
Focal segmental
glomerulosclerosis
Membranous nephropathy
Membranous Nephropathy
Things You Must Know
Autoimmune reaction
against unknown renal
antigen
Immune complexes
Thickened GBM
Subepithelial
deposits/spikes
Membranous nephropathy
Membranous nephropathy
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Nephrotic syndrome
Minimal change disease
Focal segmental
glomerulosclerosis
Membranous nephropathy
Nephritic syndrome
Symptoms of Nephritic
Syndrome
Hematuria
Oliguria,
azotemia
Hypertension
Causes of Nephritic Syndrome
Post-infectious GN, IgA
nephropathy
Immunologically-mediated
Characterized by proliferative
changes and inflammation
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Nephrotic syndrome
Minimal change disease
Focal segmental
glomerulosclerosis
Membranous nephropathy
Nephritic syndrome
Postinfectious GN
Post-Infectious
Glomerulonephritis
Things You Must Know
Child after strep
throat
Immune
complexes
Hypercellular
glomeruli
Subepithelial
humps
Post-Infectious
Glomerulonephritis
Sore throat, face bloat, pee
coke
Post-infectious glomerulonephritis
Post-infectious glomerulonephritis
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Nephrotic syndrome
Minimal change disease
Focal segmental
glomerulosclerosis
Membranous nephropathy
Nephritic syndrome
Postinfectious GN
IgA nephropathy
IgA Nephropathy
Things You Must Know
Common!
Child with hematuria after URI
IgA in mesangium
Variable prognosis
IgA nephropathy
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Tubular and interstitial
diseases
Inflammatory lesions
pyelonephritis
drug-induced interstitial
nephritis
Toxic/ischemic lesions
Acute tubular necrosis
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Tubular and interstitial
diseases
Inflammatory lesions
pyelonephritis
Pyelonephritis
Things You Must Know
Invasive kidney infection
Usually ascends from UTI
Fever, flank pain
Organisms: E. coli, Proteus
Acute pyelonephritis with
Acute pyelonephritis
Acute pyelonephritis
Cellular cast
Urinary Tract Infection
Women, elderly
Patients with catheters or
malformations
Dysuria, frequency
Organisms: E. coli, Proteus
UTI: Common Bugs
E. coli
uncomplicat
ed
complicated
Urinary catheter colonized by
Proteus
Chronic pyelonephritis
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Tubular and interstitial
diseases
Inflammatory lesions
pyelonephritis
drug-induced interstitial
nephritis
Drug-Induced Interstitial
Nephritis
Things You Must Know
Antibiotics, NSAIDS
IgE and T-cell-mediated immune
reaction
Fever, eosinophilia, hematuria
Patient usually recovers
Analgesic nephritis is diferent
(bad)
Drug-induced interstitial nephritis
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Tubular and interstitial
diseases
Inflammatory lesions
pyelonephritis
drug-induced interstitial
nephritis
Toxic/ischemic lesions
Acute tubular necrosis
Acute Tubular Necrosis
Things You Must Know
The most common cause of ARF!
Reversible tubular injury
Many causes: ischemic (shock), toxic
(drugs)
Most patients recover
Acute tubular necrosis
Acute tubular necrosis
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Tubular and interstitial
diseases
Diseases involving blood
vessels
Benign nephrosclerosis
Malignant nephrosclerosis
Benign Nephrosclerosis
Things You Must Know
Found in patients with benign
hypertension
Hyaline thickening of arterial walls
Leads to mild functional impairment
Rarely fatal
Benign nephrosclerosis
Malignant Nephrosclerosis
Things You Must Know
Arises in malignant
hypertension
Hyperplastic vessels
Ischemia of kidney
Medical emergency
Malignant Hypertension
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 nephrosclerosis
Malignant nephrosclerosis
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Tubular and interstitial diseases
Diseases involving blood vessels
Cystic diseases
Adult polycystic kidney disease
Childhood polycystic kidney disease
Adult Polycystic Kidney Disease
Things You Must Know
Autosomal dominant
Huge kidneys full of cysts
Usually no symptoms until
30s
Associated with brain
aneurysms
Adult polycystic kidney disease
Childhood Polycystic Kidney
Disease
Things You Must Know
Autosomal recessive
Numerous small cortical
cysts
Associated with liver cysts
Patients often die in infancy
Childhood polycystic kidney
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Tubular and interstitial
diseases
Diseases involving blood
vessels
Cystic diseases
Tumors
Renal cell carcinoma
Bladder carcinoma
Renal Cell Carcinoma
Things You Must Know
Derived from tubular epithelium
Smoking, hypertension, cadmium
exposure
Hematuria, abdominal mass, flank
pain
If metastatic, 5y survival = 5%
Renal cell carcinoma
Renal cell carcinoma
Renal cell carcinoma
Bladder Carcinoma
Things You Must Know
Derived from transitional epithelium
Presents with painless hematuria
Prognosis depends on grade and depth of
invasion
Overall 5y survival = 50%
Bladder carcinoma
Renal Pathology Outline
Introductory stuf
Glomerular diseases
Tubular and interstitial
diseases
Diseases involving blood
vessels
Cystic diseases
Tumors
