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Renal Pathology Kristine Krafts, M.D.
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Renal Pathology Outline
Introductory stuff Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors
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Renal Pathology Outline
Introductory stuff
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Introductory Stuff Functions of the kidney: Diseases 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
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Introductory Stuff Azotemia: BUN, creatinine
Uremia: azotemia + more problems Acute renal failure: oliguria Chronic renal failure: prolonged uremia
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Introductory Stuff Massive proteinuria Hypoalbuminemia Edema
Hyperlipidemia/-uria Nephrotic syndrome Hematuria Oliguria Azotemia Hypertension Nephritic syndrome
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Renal Pathology Outline
Introductory stuff Glomerular diseases
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Diffuse thickening of the glomerular basement membrane.
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Normal glomerulus
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Renal Pathology Outline
Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy Nephritic syndrome Postinfectious GN IgA nephropathy
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Renal Pathology Outline
Introductory stuff Glomerular diseases Nephrotic syndrome
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Symptoms of Nephrotic Syndrome
Massive proteinuria Hypoalbuminemia Edema Hyperlipidemia, lipiduria
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Causes of Nephrotic Syndrome
Adults: systemic disease (diabetes) Children: minimal change disease Characterized by loss of foot processes
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Renal Pathology Outline
Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease
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Minimal Change Disease
Things You Must Know #1 cause of nephrotic syndrome in children Loss of foot processes Pathogenesis unknown Good prognosis
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Minimal change disease
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Normal glomerulus
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Minimal change disease
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Minimal change disease
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Renal Pathology Outline
Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis
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Focal Segmental Glomerulosclerosis
Things You Must Know Primary or secondary (HIV, heroin, hypertension) Some (focal) glomeruli show partial (segmental) hyalinization Unknown pathogenesis Poor prognosis HIV Heroin Hypertension Sometimes primary, sometimes associated with other conditions (HIV, heroin nephropathy, hypertension), sometimes a result of other forms of GN Especially important to distinguish this cause of nephrotic syndrome from MCD in kids (because very different prognosis) Poor prognosis: half of patients with FSGS get end stage renal failure within 10 years. Loss of foot processes. The hyalinosis and sclerosis stem from entrapment of plasma proteins in extremely hyperpermeable foci and increased ECM deposition. The recurrence of proteinuria, sometimes within 24 hours after transplantation, with subsequent progression to overt lesions of FSGS, suggests that a circulating factor, perhaps a cytokine, may be the cause of the epithelial damage in some patients ----
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Focal segmental glomerulosclerosis
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Renal Pathology Outline
Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy
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Membranous Nephropathy
Things You Must Know Autoimmune reaction against unknown renal antigen Immune complexes Thickened GBM Subepithelial deposits/spikes
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Membranous nephropathy
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Membranous nephropathy
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Renal Pathology Outline
Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy Nephritic syndrome
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Symptoms of Nephritic Syndrome
Hematuria Oliguria, azotemia Hypertension
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Causes of Nephritic Syndrome
Post-infectious GN, IgA nephropathy Immunologically-mediated Characterized by proliferative changes and inflammation
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Renal Pathology Outline
Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy Nephritic syndrome Postinfectious GN
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Post-Infectious Glomerulonephritis
Things You Must Know Child after strep throat Immune complexes Hypercellular glomeruli Subepithelial humps
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Post-Infectious Glomerulonephritis
“Sore throat, face bloat, pee coke”
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Post-infectious glomerulonephritis
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Post-infectious glomerulonephritis
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Renal Pathology Outline
Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy Nephritic syndrome Postinfectious GN IgA nephropathy
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IgA Nephropathy Things You Must Know Common!
Child with hematuria after URI IgA in mesangium Variable prognosis
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IgA nephropathy
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Renal Pathology Outline
Introductory stuff Glomerular diseases Tubular and interstitial diseases Inflammatory lesions pyelonephritis drug-induced interstitial nephritis Toxic/ischemic lesions Acute tubular necrosis
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Renal Pathology Outline
Introductory stuff Glomerular diseases Tubular and interstitial diseases Inflammatory lesions pyelonephritis
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Pyelonephritis Things You Must Know Invasive kidney infection
Usually ascends from UTI Fever, flank pain Organisms: E. coli, Proteus
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Acute pyelonephritis with abscesses
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Acute pyelonephritis
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Acute pyelonephritis
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Cellular cast
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Urinary Tract Infection
Women, elderly Patients with catheters or malformations Dysuria, frequency Organisms: E. coli, Proteus
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UTI: Common Bugs E. coli uncomplicated complicated
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Urinary catheter colonized by Proteus
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Chronic pyelonephritis
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Renal Pathology Outline
Introductory stuff Glomerular diseases Tubular and interstitial diseases Inflammatory lesions pyelonephritis drug-induced interstitial nephritis
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Drug-Induced Interstitial Nephritis
Things You Must Know Antibiotics, NSAIDS IgE and T-cell-mediated immune reaction Fever, eosinophilia, hematuria Patient usually recovers Analgesic nephritis is different (bad)
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Drug-induced interstitial nephritis
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Renal Pathology Outline
Introductory stuff Glomerular diseases Tubular and interstitial diseases Inflammatory lesions pyelonephritis drug-induced interstitial nephritis Toxic/ischemic lesions Acute tubular necrosis
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Acute Tubular Necrosis
Things You Must Know The most common cause of ARF! Reversible tubular injury Many causes: ischemic (shock), toxic (drugs) Most patients recover
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Acute tubular necrosis
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Acute tubular necrosis
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Renal Pathology Outline
Introductory stuff Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Benign nephrosclerosis Malignant nephrosclerosis
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Benign Nephrosclerosis
Things You Must Know Found in patients with benign hypertension Hyaline thickening of arterial walls Leads to mild functional impairment Rarely fatal
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Benign nephrosclerosis
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Malignant Nephrosclerosis
Things You Must Know Arises in malignant hypertension Hyperplastic vessels Ischemia of kidney Medical emergency
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Malignant Hypertension
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%
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Malignant nephrosclerosis
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Malignant nephrosclerosis
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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
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Adult Polycystic Kidney Disease
Things You Must Know Autosomal dominant Huge kidneys full of cysts Usually no symptoms until 30s Associated with brain aneurysms
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Adult polycystic kidney disease
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Childhood Polycystic Kidney Disease
Things You Must Know Autosomal recessive Numerous small cortical cysts Associated with liver cysts Patients often die in infancy
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Childhood polycystic kidney disease
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Renal Pathology Outline
Introductory stuff Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal cell carcinoma Bladder carcinoma
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Renal Cell Carcinoma Things You Must Know
Derived from tubular epithelium Smoking, hypertension, cadmium exposure Hematuria, abdominal mass, flank pain If metastatic, 5y survival = 5%
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Renal cell carcinoma
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Renal cell carcinoma
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Renal cell carcinoma
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Bladder Carcinoma Things You Must Know
Derived from transitional epithelium Presents with painless hematuria Prognosis depends on grade and depth of invasion Overall 5y survival = 50%
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Bladder carcinoma
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Renal Pathology Outline
Introductory stuff Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors
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