1. Renal Pathology

2. Introduction: 150gm: each kidney 1700 liters of blood filtered  180 L of G. filtrate  1.5 L of urine / day. Kidney is a retro-peritoneal organ Blood supply: Renal Artery & Vein One half of kidney is sufficient – reserve kidney function: Filtration, Excretion, Secretion, Hormone synthesis.

3. Kidney Location:

4. Kidney Anatomy:

5. Renal Pathology Outline Glomerular diseases: Glomerulonephritis Tubular diseases: Acute tubular necrosis interstitial diseases: Pyelonephritis Diseases involving blood vessels: Nephrosclerosis Cystic diseases Tumors

6. Clinical Syndromes: Nephritic syndrome. –Oliguria, Haematuria, Proteinuria, Oedema. Nephrotic syndrome. –Gross proteinuria, hyperlipidemia, Acute renal failure –Oliguria, loss of Kidney function - within weeks Chronic renal failure. –Over months and years - Uremia

7. Introduction Functions 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

9. Azotemia:  BUN, creatinine Uremia: azotemia + more problems Acute renal failure: oliguria Chronic renal failure: prolonged uremia Abnormal findings

10. Hematuria Oliguria Azotemia Hypertension Nephritic syndrome Massive proteinuria Hypoalbuminemia Edema Hyperlipidemia/-uria Nephrotic syndrome

14. Glomerular diseases –Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy –Nephritic syndrome Post-infectious GN IgA (immune) nephropathy

15. Nephrotic Syndrome Massive proteinuria Hypoalbuminemia Edema Hyperlipidemia

16. Adults: systemic disease (diabetes) Children: minimal change disease Characterized by loss of foot processes Good prognosis Causes

17. Minimal change disease

18. Normal glumerular structure

19. Normal glomerulusMinimal change disease

20. Focal Segmental Glomerulosclerosis Primary or secondary Some (focal) glomeruli show partial (segmental) hyalinization Unknown pathogenesis Poor prognosis

21. Focal segmental glomerulosclerosis

22. Membranous Glomerulonephritis Autoimmune reaction against unknown renal antigen Immune complexes Thickened GBM Subepithelial deposits

23. Membranous glomerulonephritis

24. Nephritic Syndrome Hematuria Oliguria, azotemia Hypertension

25. Post-infectious GN, IgA nephropathy Immunologically-mediated Characterized by proliferative changes and inflammation Causes

26. Post-Infectious Glomerulonephritis Child after streptococcal throat infection Immune complexes Hypercellular glomeruli Subepithelial humps

27. Post-infectious glomerulonephritis

28. IgA Nephropathy Common! Child with hematuria after (URI) Upper Respiratory Infection IgA in mesangium Variable prognosis

29. IgA nephropathy

30. Tubular and interstitial diseases –Inflammatory lesions pyelonephritis

31. Pyelonephritis Invasive kidney infection Usually ascends from UTI Fever, flank pain Organisms: E. coli, Proteus

32. Women, elderly Patients with catheters or mal-formations Dysuria, frequency Organisms: E. coli, Proteus Urinary Tract Infection

33. Acute pyelonephritis with abscesses

34. Pyelonephritis

35. Cellular cast

37. Chronic pyelonephritis

38. Drug-Induced Interstitial Nephritis Antibiotics, NSAIDS IgE and T-cell-mediated immune reaction Fever, eosinophilia, hematuria Patient usually recovers Analgesic nephritis is different (bad)

39. Drug-induced interstitial nephritis

40. Acute Tubular Necrosis The most common cause of ARF! Reversible tubular injury Many causes: ischemic (shock), toxic (drugs) Most patients recover

41. Acute tubular necrosis

42. Benign Nephrosclerosis Found in patients with benign hypertension Hyaline thickening of arterial walls Leads to mild functional impairment Rarely fatal

43. Benign nephrosclerosis

44. Malignant nephrosclerosis Arises in malignant hypertension Hyperplastic vessels Ischemia of kidney Medical emergency

45. 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% Malignant Hypertension

46. Malignant hypertension

47. Adult Polycystic Kidney Disease Autosomal dominant Huge kidneys full of cysts Usually no symptoms until 30 years Associated with brain aneurysms.

48. Adult polycystic kidney disease

49. Childhood Polycystic Kidney Disease Autosomal recessive Numerous small cortical cysts Associated with liver cysts Patients often die in infancy

50. Childhood polycystic kidney disease

51. Medullary Cystic Kidney Disease Chronic renal failure in children Complex inheritance Kidneys contracted, with many cysts Progresses to end-stage renal disease

52. Tumors –Renal cell carcinoma –Bladder carcinoma

53. Renal Cell Carcinoma Derived from tubular epithelium Smoking, hypertension, cadmium exposure Hematuria, abdominal mass, flank pain If metastatic, 5y survival = 5%

54. Renal cell carcinoma

55. Bladder Carcinoma Derived from transitional epithelium Present with painless hematuria Prognosis depends on grade and depth of invasion Overall 5y survival = 50%

57. Bladder carcinoma