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Renal Pathology II

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Renal Pathology II Poststreptococcal GN Other Glomerular Diseases Acute Pyelonephritis Vascular Disease Acute Tubular Necrosis Kidney Stones (Urolithiasis) – PowerPoint PPT presentation

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Title: Renal Pathology II


1
Renal Pathology II
  • Poststreptococcal GN
  • Other Glomerular Diseases
  • Acute Pyelonephritis
  • Vascular Disease
  • Acute Tubular Necrosis
  • Kidney Stones (Urolithiasis)
  • End Stage Renal Disease
  • Cancer

2
Acute Glomerulonephritis
  • Acute Nephritic Syndrome
  • hematuria, red blood cells casts, azotemia,
    oliguria and hypertension
  • proteinuria and edema (not as severe as in the
    nephrotic syndrome)
  • inflammation/proliferation in the glomeruli
  • Acute Post-Streptococcal GN

3
Acute Post-Streptococcal GN
  • occurs at any age, most common ages 6-10
  • onset 1-2 weeks after pharyngitis or skin
    infection
  • malaise, fever, nausea, oliguria, hematuria
    (red-brown)
  • 95 of kids recover completely, 60 of adults
  • small develop rapidly progressive GN

4
Acute Post-Streptococcal GN
  • light gloms enlarged, hypercellular, bloodless
  • endocapillary prolilferation and infiltration by
    WBCs (PMNs, monocytes)
  • endothelial cells are swollen
  • tubules contain RBC casts

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Acute Post-Streptococcal GN
  • IF granular deposits of ICs in the mesangium
    and along the capillary BM
  • EM large, electron dense subepithelial deposits
    (humps)
  • Complement levels are decreased
  • group A ?-hemolytic streptococci
  • types 12, 4 and 1 are nephritogenic

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Other Glomerular Diseases
  • Systemic Lupus Erythematosus (SLE)
  • Nephritic (sometimes nephrotic) syndrome
  • ICs with complement in the glomerular basement
    membrane and mesangium
  • IgA Nephropathy (Berger Disease)
  • Most common glomerular disease in the world
  • IgA is deposited in the mesangium
  • Causes hematuria (often microscopic)
  • Not aggressive, 25-50 develop CRF in 20 yrs

9
Pyelonephritis
  • disease affecting the tubules, interstitium and
    renal pelvis
  • Two forms
  • Acute Pyelo often due to bacterial infection
  • Chronic Pyelo complex, infection plays a role,
    but reflux obstruction may also contribute

10
Acute Pyelonephritis
  • sudden onset of costovertebral angle pain
  • dysuria, frequency and urgency
  • pyuria is often present
  • good (rapid) response to antibiotics
  • septicemia is a complication in immunosuppressed
    patients

11
Acute Pyelonephritis
  • Kidney surface shows multiple, discrete areas
    that correspond to abscesses
  • patchy acute interstitial and tubular
    inflammation (PMNs)
  • glomeruli are not usually involved
  • papillary necrosis, pyonephrosis, perinephric
    abscess

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Acute Pyelonephritis
  • predisposing conditions
  • Urinary tract obstruction, instrumentation,
    vesicoureteral reflux, pregnancy, gender and age,
    preexisting renal lesions, diabetes,
    immunosuppression

15
Chronic Pyelonephritis
16
Chronic Pyelonephritis
17
Vascular Disease Benign Nephrosclerosis
  • Very common problem, elderly patients
  • Hypertension and diabetes contribute
  • By itself doesnt usually cause RF
  • Narrowing of the lumen of arterioles by
    thickening and hyalinization
  • Kidneys size is decreased, cortex is thinned,
    tubular atrophy, interstitial fibrosis, small
    gloms

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Acute Tubular Necrosis (ATN)
  • the most common cause of acute renal failure
  • 2 major causes Ischemia (most common) and
    toxic injury (e.g. ethylene glycol)
  • decreased urine output, azotemia
  • fluid overload and uremia develops
  • necrosis of tubular epithelial cells
  • May be segmental (ischemia) or continuous (toxic)

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Urolithiasis Kidney Stones
  • occur in 5-10 of US population
  • peak age is 20-30s, Males gt females
  • Most common site is renal pelvis or calyx
  • any part of the urinary tract is possible tho
  • Small stones (ureter) cause colic
  • Urinary obstruction, ulceration, bleeding
  • 80 of stones are unilateral

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Urolithiasis
  • 75 of stones composed of calcium oxalate or
    oxalate admixed with calcium phosphate
  • 50 of pts have hypercalciuria
  • hyperparathyroidism, sarcoidosis, increased GI
    uptake of calcium

24
End Stage Renal Disease
  • Extensively scarred kidneys in which there is
    little (or no) evidence of the original disease
    process
  • Advanced uremia
  • Kidneys are quite small ( lt 50 gms each)
  • Gloms are sclerosed, crowded, tubular atrophy,
    vascular sclerosis, interstitial fibrosis

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Tumors
  • Both benign malignant tumors occur in the
    urinary tract
  • Most common malignant tumors of the Kidney
    Renal Cell Carcinoma, Nephroblastoma (Wilms)
  • Tumors of the lower urinary tract (bladder) are
    about 2x more common

27
Renal Cell Carcinoma
  • 2-3 of all cancers in adults (30,000/yr)
  • most common in 50-60s, MF gt 21
  • smoking is a risk factor, familial cases related
    to a deleted tumor suppressor gene (VHL)
  • most arise from tubular epithelium
  • Hematuria and flank pain (dull) common
  • Also fever and polycythemia (erythropoietin)

28
Renal Cell Carcinoma
  • tumors are usually solitary large, yellow with
    areas of hemorrhage necrosis
  • cells have clear cytoplasm (lipid)
  • Clear cell carcinoma
  • May extend thru the capsule, invade the pelvis
    and ureter, invasion of the renal vein is common

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Wilms Tumor
  • Nephroblastoma
  • Occur in children lt 5 yrs (between 2-5 yrs)
  • 4th most common malignancy in kids lt 4 yrs
  • Leukemia, Retinoblastoma, Neuroblastoma
  • 3 groups of congenital malformations are
    associated with Wilms tunor (chromosome 11)

32
Wilms Tumor
  • patients have a large palpable abdominal mass
  • tumor composed of poorly formed epithelial
    structures (tubules) and loose mesenchymal stroma
  • nephrectomy and chemotherapy produces 90 2-year
    survival

33
Wilm Tumor
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35
What the hell does it all mean?
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