Pathology of the Kidney and Its Collecting System Dr. Francisco G. La Rosa Francisco.LaRosa@UCHSC.edu Home Page

Embriology of the Kidney and Collecting System Home Page

Anatomy of the Kidney Home Page

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

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

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

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

Schematic Representation of a Glomerular Lobe Home Page

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

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

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

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

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

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

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

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

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

Acute Nephritic Syndrome Home Page

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

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

(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

Proliferative Glomerulonephritis IgG Proliferative Glomerulonephritis Systemic Lupus Home Page

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

Pathways of Renal Infection Home Page

Acute Cystitis Home Page

Hydronephrosis and chronic obstructive pyelonephritis Home Page

Chronic pyelonephritis Home Page

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

Acute Renal Infarct Home Page

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

CONTINUE IN LECTURE 2 Home Page