1. PATHOLOGY OF KIDNEYS VII. practical training 3 rd year General Medicine

2. Normal glomerulus 1 Capillary lumen 2 Basement membrane 3 Podocytyes 4 Mesangial cells 5 Proximal tubulus 6 Bowman’s capsule 7 Mesangial matrix 8 Distal tubulus 9 Macula densa 1 1 2 3 4 5 6 7 8 9

3. Capillary loops – electronogram 1 Podocytes Podocytal processus Basement membrane Endothelium Mesangial cell Mesangial matrix Capillary lumen

4. Cystic kidney diseases

6. Infantile cystosis (Microcystosis) of kidneys

7. Microcystosis

8. Vascular nephrosclerosis

12. Classification of glomerular diseases Primary Glomerular Diseases Glomerulonefritis in Systemic Diseases Glomerular Lesions in Vascular Diseases Glomerular Lesions in Metabolic Diseases Hereditary Nephropathies Miscellaneous Glomerular Diseases End Stage Kidney Glomerular Lesions Following Transplantation

13. Aetiological clasification of glomerular injury Non-immunological hyperfiltration BM polyanion loss BM inherited deffects ischemic Immunological circuluting immune complex in situ immune complex anti-basement membrane antibody (anti-GBM) ANCA antibody T-cell mediated cytotoxicity

14. Nomenclature of glomerular injury Diffuse - all glomeruli Focal - some glomeruli, others unaffected Global - the whole glomerulus Segmental - only part of the glomerulus

15. Light microscopic hanges Proliferative: increased cell numbers (proliferation, PNM and macrophages recruitment from the circulation) Membranous: BM thickening Membrano-proliferative: a combination of the two above features Crescentic: proliferation of cells lining Bowman’s capsule

16. Diabetic glomerulosclerosis (Kimmelstiel-Wilson) 1 hyaline deposits in mesangial matrix of glomerulus 1

17. Diabetic glomerulosclerosis (Kimmelstiel-Wilson) 1 hyaline globules in mesangial matrix of glomerulus 2 capillaries around hyaline globules 3 hyalinosis of mesangium 1 2 3

18. Armani’s cells (PAS)

19. Endocapillary proliferative glomerulonefritis 1 Reduction of capillary lumen 2 Bulge and proliferation of cellular formation of glomerulus 1 2 2 2

20. Endocapillary proliferative glomerulonefritis immunoflourescenc-subendothelial immune-complex deposit 1 1 Granular subendothelial deposits on basal membrane

21. E Swelling endothelial cells 1 Basal membrane Stars- subendothelial deposits of immunoglobulins on basal membrane 1 Endocapillary proliferative glomerulonefritis, electronogram

22. Diffuse sclerozing glomerulonefritis

24. Rapidly progressive (crescentic) glomerulonephritis 1 Extracapillary proliferation of epithelial cells of Bowman capsule and fibrin – compression of glomerular capillaries 2 Regresive alteration of glomerular capillaries 1 2 2

25. Rapidly progressive (crescentic) glomerulonephritis 1 Basal membrane of Bowman capsule 2 Fibrin 3 Hyaline deposits in glomerular capillaries 1 2 3 3 3

26. Acute suppurative pyelonephritis

29. Chronic pyelonephritis

30. Chronic pyelonefritis (end stage kidney, anamnesis of prostatic hypertrophy) Dilatated ureter Capsule of kidney End stage kidney Kidney without big changes Chronic urocystitis

31. Amyloid nephropathy

33. Biliary nephrosis

34. Hydronephrosis

36. Wilms’ tumour (nephroblastoma)

37. 1 1 Stromal component 2 Blastema component 3 Epithelial component 1 2 2 3

38. Nephroblastoma

39. Renal cell carcinoma, conventional type tumour Lower pole of kidney Kidney in section Tumour invasion inside vein in hilus

40. Renal cell carcinoma, clear cell type