Renal pathology for web

Slide1 : Renal Pathology Kristine Krafts, M.D. October 16, 2007


Slide3 : $2,500,000


Slide4 : “Like blood, urine is rich in DNA. The Oxidations are portraits of Victor. They're also self-portraits and portraits of assistant Ronnie Cutrone. Doggedly marked territories, they trace signs of identity, even if that identity is unknown (or unknowable).” - Bruce Haines (Art Critic)


Slide5 : “Art is what you can get away with.” - Andy Warhol


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors


Renal Pathology Outline : Renal Pathology Outline Introductory stuff


Introductory Stuff : Introductory Stuff 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


Slide10 : Azotemia:  BUN, creatinine Uremia: azotemia + more problems Acute renal failure: oliguria Chronic renal failure: prolonged uremia Introductory Stuff


Slide11 : Introductory Stuff


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy Nephritic syndrome Postinfectious GN IgA nephropathy


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome


Nephrotic Syndrome : Nephrotic Syndrome Massive proteinuria Hypoalbuminemia Edema Hyperlipidemia, lipiduria


Nephrotic Syndrome : Nephrotic Syndrome Adults: systemic disease (diabetes) Children: minimal change disease Characterized by loss of foot processes Causes


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease


Minimal Change Disease : Minimal Change Disease #1 cause of nephrotic syndrome in children Loss of foot processes Pathogenesis unknown Good prognosis Things you must know


Slide24 : Minimal change disease


Slide25 : Normal glomerulus


Slide26 : Minimal change disease


Slide27 : Minimal change disease


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis


Focal Segmental Glomerulosclerosis : Focal Segmental Glomerulosclerosis Primary or secondary Some (focal) glomeruli show partial (segmental) hyalinization Unknown pathogenesis Poor prognosis Things you must know


Slide30 : Focal segmental glomerulosclerosis


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous glomerulonephritis


Membranous Glomerulonephritis : Membranous Glomerulonephritis Autoimmune reaction against unknown renal antigen Immune complexes Thickened GBM Subepithelial deposits/spikes Things you must know


Slide33 : Membranous glomerulonephritis


Slide34 : Membranous glomerulonephritis


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous glomerulonephritis Nephritic syndrome


Nephritic Syndrome : Nephritic Syndrome Hematuria Oliguria, azotemia Hypertension


Nephritic Syndrome : Nephritic Syndrome Post-infectious GN, IgA nephropathy Immunologically-mediated Characterized by proliferative changes and inflammation Causes


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous glomerulonephritis Nephritic syndrome Postinfectious GN


Post-Infectious Glomerulonephritis : Post-Infectious Glomerulonephritis Child after strep throat Immune complexes Hypercellular glomeruli Subepithelial humps Things you must know


Post-Infectious Glomerulonephritis : Post-Infectious Glomerulonephritis “Sore throat, face bloat, pee coke” Mnemonic


Slide41 : Post-infectious glomerulonephritis


Slide42 : Post-infectious glomerulonephritis


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous glomerulonephritis Nephritic syndrome Postinfectious GN IgA nephropathy


IgA Nephropathy : IgA Nephropathy Common! Child with hematuria after URI IgA in mesangium Variable prognosis Things you must know


Slide45 : IgA nephropathy


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Inflammatory lesions pyelonephritis drug-induced interstitial nephritis Toxic/ischemic lesions Acute tubular necrosis


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Inflammatory lesions pyelonephritis


Pyelonephritis : Pyelonephritis Invasive kidney infection Usually ascends from UTI Fever, flank pain Organisms: E. coli, Proteus Things you must know


Slide49 : Acute pyelonephritis with abscesses


Slide50 : Pyelonephritis


Slide51 : Pyelonephritis


Slide52 : Cellular cast


Pyelonephritis : Pyelonephritis Women, elderly Patients with catheters or malformations Dysuria, frequency Organisms: E. coli, Proteus Urinary Tract Infection


Pyelonephritis : E. coli uncomplicated complicated Pyelonephritis UTI: Causative Organisms


Slide56 : Urinary catheter colonized by Proteus


Slide57 : Chronic pyelonephritis


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Inflammatory lesions pyelonephritis drug-induced interstitial nephritis


Drug-Induced Interstitial Nephritis : Drug-Induced Interstitial Nephritis Antibiotics, NSAIDS IgE and T-cell-mediated immune reaction Fever, eosinophilia, hematuria Patient usually recovers Analgesic nephritis is different (bad) Things you must know


Slide60 : Drug-induced interstitial nephritis


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Inflammatory lesions pyelonephritis drug-induced interstitial nephritis Toxic/ischemic lesions Acute tubular necrosis


Acute Tubular Necrosis : Acute Tubular Necrosis The most common cause of ARF! Reversible tubular injury Many causes: ischemic (shock), toxic (drugs) Most patients recover Things you must know


Slide63 : Acute tubular necrosis


Slide64 : Acute tubular necrosis


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Benign nephrosclerosis Malignant nephrosclerosis


Benign Nephrosclerosis : Benign Nephrosclerosis Found in patients with benign hypertension Hyaline thickening of arterial walls Leads to mild functional impairment Rarely fatal Things you must know


Slide67 : Benign nephrosclerosis


Malignant nephrosclerosis : Malignant nephrosclerosis Arises in malignant hypertension Hyperplastic vessels Ischemia of kidney Medical emergency Things you must know


Malignant nephrosclerosis : Malignant nephrosclerosis 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


Slide70 : Malignant hypertension


Slide71 : Malignant hypertension


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Adult polycystic kidney disease Childhood polycystic kidney disease Medullary cystic disease


Adult Polycystic Kidney Disease : Adult Polycystic Kidney Disease Autosomal dominant Huge kidneys full of cysts Usually no symptoms until 30s Associated with brain aneurysms Things you must know


Slide74 : Adult polycystic kidney disease


Childhood Polycystic Kidney Disease : Childhood Polycystic Kidney Disease Autosomal recessive Numerous small cortical cysts Associated with liver cysts Patients often die in infancy Things you must know


Slide76 : Childhood polycystic kidney disease


Medullary Cystic Kidney Disease : Medullary Cystic Kidney Disease Chronic renal failure in children Complex inheritance Kidneys contracted, with many cysts Progresses to end-stage renal disease Things you must know


Renal Pathology Outline : Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal cell carcinoma Bladder carcinoma


Renal Cell Carcinoma : Renal Cell Carcinoma Derived from tubular epithelium Smoking, hypertension, cadmium exposure Hematuria, abdominal mass, flank pain If metastatic, 5y survival = 5% Things you must know


Slide80 : Renal cell carcinoma


Slide81 : Renal cell carcinoma


Slide82 : Renal cell carcinoma


Bladder Carcinoma : Bladder Carcinoma Derived from transitional epithelium Present with painless hematuria Prognosis depends on grade and depth of invasion Overall 5y survival = 50% Things you must know


Slide85 : Bladder carcinoma