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

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

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

Renal Pathology Outline Introductory stuff

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

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

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

Renal Pathology Outline Introductory stuff Glomerular diseases

Normal glomerulus

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

Renal Pathology Outline Introductory stuff Glomerular diseases Nephro%c syndrome

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

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

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

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

Minimal change disease

Normal glomerulus

Minimal change disease

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

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

Focal segmental glomerulosclerosis

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

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

Membranous nephropathy

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

Symptoms of Nephri%c Syndrome Hematuria Oliguria, azotemia Hypertension

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

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

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

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

Post- infec%ous glomerulonephri%s

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

IgA nephropathy

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

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

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

Acute pyelonephri%s with abscesses

Acute pyelonephri%s

Cellular cast

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

UTI: Common Bugs E. coli uncomplicated complicated

Urinary catheter colonized by Proteus

Chronic pyelonephri%s

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

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)

Drug- induced inters%%al nephri%s

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

Acute tubular necrosis

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

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

Benign nephrosclerosis

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

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%

Malignant nephrosclerosis

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

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

Adult polycys%c kidney disease

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

Childhood polycys%c kidney disease

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

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%

Renal cell carcinoma

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%

Bladder carcinoma

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