Renal. Pathology. Kris%ne Kra*s, M.D.

Transcription

1 Renal Pathology Kris%ne Kra*s, M.D.

2 Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and inters%%al diseases Diseases involving blood vessels Cys%c diseases Tumors

3 Renal Pathology Outline Introductory stuff

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5 Introductory Stuff Func%ons of the kidney: excre%on of waste products regula%on of water/salt maintenance of acid/base balance secre%on of hormones Diseases of the kidney glomeruli tubules inters%%um vessels

6 Introductory Stuff Azotemia: BUN, crea%nine Uremia: azotemia + more problems Acute renal failure: oliguria Chronic renal failure: prolonged uremia

7 Introductory Stuff Nephro%c syndrome Massive proteinuria Hypoalbuminemia Edema Hyperlipidemia/- uria Nephri%c syndrome Hematuria Oliguria Azotemia Hypertension

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11 Renal Pathology Outline Introductory stuff Glomerular diseases

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14 Normal glomerulus

15 Renal Pathology Outline Introductory stuff Glomerular diseases Nephro%c syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy Nephri%c syndrome Pos%nfec%ous GN IgA nephropathy

16 Renal Pathology Outline Introductory stuff Glomerular diseases Nephro%c syndrome

17 Symptoms of Nephro%c Syndrome Massive proteinuria Hypoalbuminemia Edema Hyperlipidemia, lipiduria

18 Causes of Nephro%c Syndrome Adults: systemic disease (diabetes) Children: minimal change disease Characterized by loss of foot processes

19 Renal Pathology Outline Introductory stuff Glomerular diseases Nephro%c syndrome Minimal change disease

20 Minimal Change Disease Things You Must Know #1 cause of nephro%c syndrome in children Loss of foot processes Pathogenesis unknown Good prognosis

21 Minimal change disease

22 Normal glomerulus

23 Minimal change disease

24 Minimal change disease

25 Renal Pathology Outline Introductory stuff Glomerular diseases Nephro%c syndrome Minimal change disease Focal segmental glomerulosclerosis

26 Focal Segmental Glomerulosclerosis Things You Must Know Primary or secondary (HIV, heroin, hypertension) Some (focal) glomeruli show par%al (segmental) hyaliniza%on Unknown pathogenesis Poor prognosis

27 Focal segmental glomerulosclerosis

28 Renal Pathology Outline Introductory stuff Glomerular diseases Nephro%c syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy

29 Membranous Nephropathy Things You Must Know Autoimmune reac%on against unknown renal an%gen Immune complexes Thickened GBM Subepithelial deposits/spikes

30 Membranous nephropathy

31 Membranous nephropathy

32 Renal Pathology Outline Introductory stuff Glomerular diseases Nephro%c syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy Nephri%c syndrome

33 Symptoms of Nephri%c Syndrome Hematuria Oliguria, azotemia Hypertension

34 Causes of Nephri%c Syndrome Post- infec%ous GN, IgA nephropathy Immunologically- mediated Characterized by prolifera%ve changes and inflamma%on

35 Renal Pathology Outline Introductory stuff Glomerular diseases Nephro%c syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy Nephri%c syndrome Pos%nfec%ous GN

36 Post- Infec%ous Glomerulonephri%s Things You Must Know Child a*er strep throat Immune complexes Hypercellular glomeruli Subepithelial humps

37 Post- Infec%ous Glomerulonephri%s Sore throat, face bloat, pee coke

38 Post- infec%ous glomerulonephri%s

39 Post- infec%ous glomerulonephri%s

40 Renal Pathology Outline Introductory stuff Glomerular diseases Nephro%c syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy Nephri%c syndrome Pos%nfec%ous GN IgA nephropathy

41 IgA Nephropathy Things You Must Know Common! Child with hematuria a*er URI IgA in mesangium Variable prognosis

42 IgA nephropathy

43 Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and inters%%al diseases Inflammatory lesions pyelonephri%s drug- induced inters%%al nephri%s Toxic/ischemic lesions Acute tubular necrosis

44 Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and inters%%al diseases Inflammatory lesions pyelonephri%s

45 Pyelonephri%s Things You Must Know Invasive kidney infec%on Usually ascends from UTI Fever, flank pain Organisms: E. coli, Proteus

46 Acute pyelonephri%s with abscesses

47 Acute pyelonephri%s

48 Acute pyelonephri%s

49 Cellular cast

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51 Urinary Tract Infec%on Women, elderly Pa%ents with catheters or malforma%ons Dysuria, frequency Organisms: E. coli, Proteus

52 UTI: Common Bugs E. coli uncomplicated complicated

53 Urinary catheter colonized by Proteus

54 Chronic pyelonephri%s

55 Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and inters%%al diseases Inflammatory lesions pyelonephri%s drug- induced inters%%al nephri%s

56 Drug- Induced Inters%%al Nephri%s Things You Must Know An%bio%cs, NSAIDS IgE and T- cell- mediated immune reac%on Fever, eosinophilia, hematuria Pa%ent usually recovers Analgesic nephri%s is different (bad)

57 Drug- induced inters%%al nephri%s

58 Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and inters%%al diseases Inflammatory lesions pyelonephri%s drug- induced inters%%al nephri%s Toxic/ischemic lesions Acute tubular necrosis

59 Acute Tubular Necrosis Things You Must Know The most common cause of ARF! Reversible tubular injury Many causes: ischemic (shock), toxic (drugs) Most pa%ents recover

60 Acute tubular necrosis

61 Acute tubular necrosis

62 Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and inters%%al diseases Diseases involving blood vessels Benign nephrosclerosis Malignant nephrosclerosis

63 Benign Nephrosclerosis Things You Must Know Found in pa%ents with benign hypertension Hyaline thickening of arterial walls Leads to mild func%onal impairment Rarely fatal

64 Benign nephrosclerosis

65 Malignant Nephrosclerosis Things You Must Know Arises in malignant hypertension Hyperplas%c vessels Ischemia of kidney Medical emergency

66 Malignant Hypertension 5% of cases of hypertension Super- high blood pressure, encephalopathy, heart abnormali%es First sign o*en headache, scotomas Decreased blood flow to kidney leads to increased renin, which leads to increased BP! 5y survival: 50%

67 Malignant nephrosclerosis

68 Malignant nephrosclerosis

69 Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and inters%%al diseases Diseases involving blood vessels Cys%c diseases Adult polycys%c kidney disease Childhood polycys%c kidney disease

70 Adult Polycys%c Kidney Disease Things You Must Know Autosomal dominant Huge kidneys full of cysts Usually no symptoms un%l 30s Associated with brain aneurysms

71 Adult polycys%c kidney disease

72 Childhood Polycys%c Kidney Disease Things You Must Know Autosomal recessive Numerous small cor%cal cysts Associated with liver cysts Pa%ents o*en die in infancy

73 Childhood polycys%c kidney disease

74 Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and inters%%al diseases Diseases involving blood vessels Cys%c diseases Tumors Renal cell carcinoma Bladder carcinoma

75 Renal Cell Carcinoma Things You Must Know Derived from tubular epithelium Smoking, hypertension, cadmium exposure Hematuria, abdominal mass, flank pain If metasta%c, 5y survival = 5%

76 Renal cell carcinoma

77 Renal cell carcinoma

78 Renal cell carcinoma

79 Bladder Carcinoma Things You Must Know Derived from transi%onal epithelium Presents with painless hematuria Prognosis depends on grade and depth of invasion Overall 5y survival = 50%

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81 Bladder carcinoma

82 Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and inters%%al diseases Diseases involving blood vessels Cys%c diseases Tumors