1. Dr. Amar C. Al-Rikabi Dr. Hala Kassouf Kfoury

2. Objectives 1- Introduction to the renal pathology 2- Cystic diseases 3- Acute Kidney Injury 4- Definitions, Types, Clinical Overview, Causes 5- Pathological findings 6- Differential Diagnosis

3. Lecture -1:

6. CAPILLARY WALL MESANGIUM GBM FOOT PROCESSES

7. BC CL US End Ep

8. This paraffin embedded 2µm section illustrates a normal glomerulus with normal vascular pole with minimal periglomerular interstitial fibrosis and surrounding intact tubules

9. This glomerulus shows only minimal abnormalities by electron microscopy, with rare Vacuoles and blebs in the podocytes.

10. Bisected kidney shows a less severe form of CRD with multiple cysts and focally a significant degree of disorganization of parenchymal architecture.

11. Autosomal recessive (infantile) polycystic disease (ARPKD). Elongated streaks represent dilated tubules.

12. Cut surface of ADPKD showing variable-size, irregular cysts with no recognizable intervening normal parenchyma. Most cysts contain clear fluid and the pelvis is distorted. Histology of ADPKD shows a single glomerulus alongside several cysts

13. Late stage of ADPKD showing greatly enlarged renal profiles due to innumerable cysts of varying size replacing the renal parenchyma.

14. Acute kidney injury is a syndrome defined by a sudden loss of renal function over several hours to several days. Mayo Clin Proc. 2001;76:67-74

15. RPGN (Rapidly Progressive Glomerulonephritis) is a syndrome defined by the rapid loss of renal function over days to weeks due to acute glomerulonephritis.

16. Etiology of ARF

17. The Pathophysiology of ARF Acute renal failure PrerenalIntrarenal VascularGlomerularTubular Ischemia Toxins Pigments Interstitial PostrenalFactitious JASN 1998;9(4):710-718

18. ACUTE RENAL FAILURE I.Acute tubular necrosis (ATN) A.Clinically, rapid deterioration in renal function usually, but not always associated with oliguria. B. Many different kidney diseases may present with acute renal failure although ATN is the most common cause by far. C. Conditions associated with ATN 1. Shock 2. Sepsis 3. Incompatible blood transfusions 4. Burns 5. Crush injury 6. Drugs

19. Acute tubular necrosis (ATN) Clinicopathological entity Destruction of tubular epithelial cell Clin. acute suppression of renal function (no urine or below 400 ml/24h) Most common cause of renal failure

20. ATN : Acute tubular necrosis

23. Kidney in acute tubular necrosis (ATN) showing pale, swollen cortex and congested medulla. Elongated, stretched out, regenerating proximal tubular lining cells encompass the necrotic epithelium.

24. Acute Kidney Injury Conclusion : 1- Specify the cause of the acute kidney injury