1. Pathology of the Kidney and Its Collecting System
Dr. Francisco G. La Rosa
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2. Embriology of the Kidney and Collecting System
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3. Anatomy of the Kidney
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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)
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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
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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
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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
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8. Schematic Representation of a Glomerular Lobe
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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.
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10. Antibody-mediated glomerular injury: (A) Circulating Ag-Ab complexes, (B) Anti-basement membrane, (C) In situ Ag-Ab complexes.
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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.
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12. Mediators of immune glomerular injury.
Oxidants Proteases Eicosanoids Cytokines Growth Factors Nitric Oxide Others
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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
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15. Lipoid Nephrosis (A and C) and Membranous Glomerulonephritis (B and D).
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16. Epithelial Cells & Podocytes Antigen-Antibody Deposits
Nephrotic syndrome:
Epithelial Cells & Podocytes
Antigen-Antibody Deposits
Basement Membrane
Endothelial Cells
Capillary Lumen
Urinary Space
Mesangium
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17. IgA Nephropathy Focal mesangial proliferative glomerulonephritis IgA
Immunofluorescence in the glomeruli: IgG +, IgA +++ (shown here), IgM Negative, and C3 ++.
IgA
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18. Epithelial Cells & Podocytes Antigen-Antibody Deposits
IgA Nephropathy
Epithelial Cells & Podocytes
Antigen-Antibody Deposits
Basement Membrane
Endothelial Cells
Capillary Lumen
Urinary Space
Mesangium
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19. Acute Nephritic Syndrome
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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
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21. Acute nephritic syndrome Goodpasture's syndrome
Cast
Proliferation, glomerular crescents, necrosis
IgG linear pattern
Fibrinogen
Acute nephritic syndrome
Goodpasture's syndrome
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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 .
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23. Proliferative Glomerulonephritis
IgG
Proliferative Glomerulonephritis
Systemic Lupus
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24. Tubular and Interstitial Diseases
Tubulointerstitial Nephritis Acute pyelonephritis Chronic pyelonephritis Drug-Induced interstitial nephritis
Acute tubular necrosis
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25. Pathways of Renal Infection
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26. Acute Cystitis
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27. Hydronephrosis and chronic obstructive pyelonephritis
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28. Chronic pyelonephritis
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29. Vascular Diseases Benign nephrosclerosis
Malignant hypertension/ Malignant nephrosclerosis
Thrombotic microangiopathies
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30. Acute Renal Infarct
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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
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32. CONTINUE IN LECTURE 2
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