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Pathology of the Kidney and Its Collecting System

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Presentation on theme: "Pathology of the Kidney and Its Collecting System"— Presentation transcript:

1 Pathology of the Kidney and Its Collecting System
Dr. Francisco G. La Rosa Home Page

2 Embriology of the Kidney and Collecting System
Home Page

3 Anatomy of the Kidney Home Page

4 KIDNEY Functions: Excretion of waste products Regulation of water and salt Maintenance of acid balance Secretion of hormones and by-products Structures and Diseases: Glomeruli (immune damage) Tubuli (toxic or infections) Interstitium (toxic or infections) Blood vessels (metabolic) Home Page

5 CLINICAL MANIFESTATIONS OF RENAL DISEASE
Syndromes: Acute Nephritic syndrome Nephrotic syndrome Asymptomatic hematuria Asymptomatic proteinuria Acute renal failure Chronic renal failure Urinary tract infection (UTI) Nephrolitiasis Tumors Home Page

6 GLOMERULAR DISEASES Primary Glomerulonephritis Acute diffuse proliferative GN Rapidly progressive GN Membranous GN Lipoid nephrosis (minimal change disease) Focal segmental glomerulosclerosis Membranoproliferative GN IgA Nephropathy Chronic GN Secondary (Systemic) Diseases Systemic lupus erythematosus Diabetes mellitus Amyloidosis Goodpasture’s syndrome Polyarteritis nodosa Wagener’s granulomatosis Henoch-Scholein purpura Bacterial endocarditis Hereditary Disorders Alport’s syndrome Fabry’s disease Home Page

7 Intrarenal Vasoconstriction (Increased Endothelin; decreased NO)
Ischemia / Toxins Tubular Injury Intrarenal Vasoconstriction (Increased Endothelin; decreased NO) Tubule Obstruction Back- Leakage Reduced Glomerular Plasma Flow Reduced O2 delivery to Outer Medulla Increased Intratubular Pressure ? Direct Glomerular Effect Reduced GFR  Oliguria Acute Renal Failure Home Page

8 Schematic Representation of a Glomerular Lobe
Home Page

9 Low-power electron micrograph of rat glomerulus: CL, capillary lumen; End, endothelium
Mes, mesangium; B, basement membrane; Ep, visceral epithelial cells with foot processes; US, urinary space. Home Page

10 Antibody-mediated glomerular injury: (A) Circulating Ag-Ab complexes, (B) Anti-basement membrane, (C) In situ Ag-Ab complexes. Home Page

11 Albumin Epithelial cell injury and destruction of the basement membrane as a result of immune complex in the glomerulus. Normally, the basement cell membrane does not filter large molecules such as albumin (70,000 kD), which is present in urine if the membrane is damaged. Home Page

12 Mediators of immune glomerular injury.
Oxidants Proteases Eicosanoids Cytokines Growth Factors Nitric Oxide Others Home Page

13 Proteinuria (>3.5 g/day) General edema Hypoalbuminemia (<3gr/dL)
NEPHROTIC SYNDROME Proteinuria (>3.5 g/day) General edema Hypoalbuminemia (<3gr/dL) Hyperlipidemia Lipiduria Home Page

14 Home Page

15 Lipoid Nephrosis (A and C) and Membranous Glomerulonephritis (B and D).
Home Page

16 Epithelial Cells & Podocytes Antigen-Antibody Deposits
Nephrotic syndrome: Epithelial Cells & Podocytes Antigen-Antibody Deposits Basement Membrane Endothelial Cells Capillary Lumen Urinary Space Mesangium Home Page

17 IgA Nephropathy Focal mesangial proliferative glomerulonephritis IgA
Immunofluorescence in the glomeruli: IgG +, IgA +++ (shown here), IgM Negative, and C3 ++. IgA Home Page

18 Epithelial Cells & Podocytes Antigen-Antibody Deposits
IgA Nephropathy Epithelial Cells & Podocytes Antigen-Antibody Deposits Basement Membrane Endothelial Cells Capillary Lumen Urinary Space Mesangium Home Page

19 Acute Nephritic Syndrome
Home Page

20 Epithelial Cells & Podocytes Antigen-Antibody Deposits
Acute Nephritic Syndrome Epithelial Cells & Podocytes Antigen-Antibody Deposits Basement Membrane Endothelial Cells Capillary Lumen Urinary Space Mesangium Home Page

21 Acute nephritic syndrome Goodpasture's syndrome
Cast Proliferation, glomerular crescents, necrosis IgG linear pattern Fibrinogen Acute nephritic syndrome Goodpasture's syndrome Home Page

22 (B) Type I and Type II MGN .
Membranoproliferative Glomerulonephritis (MGN): Mesangial proliferation, basement membrane thickening, leukocyte infiltration and accentuation of lobular architecture. (B) Type I and Type II MGN . Home Page

23 Proliferative Glomerulonephritis
IgG Proliferative Glomerulonephritis Systemic Lupus Home Page

24 Tubular and Interstitial Diseases
Tubulointerstitial Nephritis Acute pyelonephritis Chronic pyelonephritis Drug-Induced interstitial nephritis Acute tubular necrosis Home Page

25 Pathways of Renal Infection
Home Page

26 Acute Cystitis Home Page

27 Hydronephrosis and chronic obstructive pyelonephritis
Home Page

28 Chronic pyelonephritis
Home Page

29 Vascular Diseases Benign nephrosclerosis
Malignant hypertension/ Malignant nephrosclerosis Thrombotic microangiopathies Home Page

30 Acute Renal Infarct Home Page

31 Malignant hypertension leads to fibrinoid necrosis of small arteries
Malignant hypertension leads to fibrinoid necrosis of small arteries. The damage to the arteries leads to formation of pink fibrin -- hence the term "fibrinoid". Thickening of the arterial wall with malignant hypertension produces a hyperplastic arteriolitis. The arteriole has an "onion skin" appearance Home Page

32 CONTINUE IN LECTURE 2 Home Page


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