1-2 pathology of uropoetic and endocrine system1-2 pathology of uropoetic and endocrine system...
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1-2
PATHOLOGY OF UROPOETIC AND ENDOCRINE SYSTEM
Dentistry
Ass.Prof.MUDr. Ján Porubský, CSc., Prof.MUDr. Pavel Babál, CSc. MUDr.Pavol Janega
MUDr.Andrea Janegová
MUDr. Zuzana Čierna
Department of pathology, Comenius University
Sasinkova 4, Bratislava
Prof. MUDr. Ľudovít Danihel, CSc.
Pathology of uropoetic system
Arteriolosclerotic nephrosclerosis (57)
• cause – hypertension → thickening of arteries, reduction of lumen
→ local ischemia
• nephrosclerosis - benign – hyaline arteriolosclerosis, intimal
thickening
- malignant - (> 200/140 mmHg) - fibrinoid necrosis,
hyperplastic intimal sclerosis
Arteriosclerotic nephrosclerosis
• cause – atherosclerosis of a.renalis, ischemic changes
Arterio- and arteriolosclerotic nephrosclerosis (57)
Arterio- and arteriolosclerotic nephrosclerosis (57)
Arterio- and arteriolosclerotic nephrosclerosis (57)
Glomerulonephritis (59,61)
• renal disease characterized by inflammation of the glomeruli
• cause –IC (local IC deposits, circulating IC), anti-GBM antibodies
• primary / secondary (SLE, vasculities, DM, infectious diseases)
• acute / rapidly progressive / chronic
• clinical presentation:
- nephritic syndrome (haematuria, mild proteinuria, hypertension,
oedema, oliguria)
- nephrotic syndrome (heavy proteinuria, hypoalbuminaemia,
oedema, hyperlipidaemia, lipiduria, hypercoagulability)
- combination
Pathology of uropoetic system
Primary glomerulonephritis
1. Acute GN a) post-streptococcal
b) non-streptococcal
2. Rapidly progressive GN
3. Minimal change disease
4. Membranous GN
5. Membrano-proliferative GN
6. Focal proliferative GN
7. Focal segmental glomerulosclerosis (FSGS)
8. IgA nephropathy
9. Chronic glomerulonephritis
Pathology of uropoetic system
Glomerulonephritis – morphological changes
Minimal change GN
(Minimal change disease. Lipoid nephrosis. Foot process disease)
- no changes on light microscopy
- on electron microscopy fusion of podocytes
- nephrotic syndrome
Focal Segmental Glomerulosclerosis (FSGS)
- focal (certain number of glomeruli) a segmental (part of
glomeruli) affection
- sclerosis of glomeruli and hyalinisation of arterioles
- nephrotic syndrome with heavy proteinuria
Focal proliferative GN (Mesangial proliferative GN)
- proliferation of mesang. and endothel. cells
- haematuria
Pathology of uropoetic system
Diffuse GN:
Membranous glomerulonephritis
(Epimembranous nephropathy)
- subepithel. "spike" deposits → thickening of BM
- subepitelial IC deposits
- without cell proliferation
- nephrotic syndrome, mostly in adults
Pathology of uropoetic system
Glomerulonephritis – morphological changes
Proliferative GN
Mesangial proliferative GN
- IgA nephropathy (Berger's disease) – most common GN in adults
- increased number of mesangial cells and matrix
- IgA deposits in mesangium
- macroscopic haematuria
Mesangiocapillary (membranoproliferative) GN
- enlarged, lobular glomeruli - proliferation of mesangial cells, matrix
and thickening of GBM („tram track“)
Diffuse mesangial proliferative glomerulonephritis
Diffuse mesangiocapillary/membranoproliferative/ glomerulonephritis
Pathology of uropoetic system
Endocapillary GN
Acute post-streptococcal GN - mostly in children
• sudden onset 1 – 2 weeks after streptococcal infection β-hemol. Strep.gr.A (pharyngitis, impetigo), CF – acute nephritic syndrome
• enlarged, hypercellular glomeruli (proliferation of mesangial, endothel., epithel. cells, Ne)
• IC deposits in glomeruli subepithelially (IgG,C3)
• recovery / rapidly progres. GN / chronic GN / chron.ren.failure
Acute non-streptococcal GN - bacteria (staphylococci, pneumococci, meningococci), viruses (hep.B, mumps), parasitic infection (toxoplasmosis), syphilis
• Micro – similar to post-streptococcal GN
• prognosis is not as good as that of post-streptococcal GN
Pathology of uropoetic system
Extracapillary (crescentic) GN
(Rapidly progressive GN, RPGN)
- proliferation of epithelial cells of Bowman capsule → formation of
crescents → compresion of capillaries
- Goodpasture’s synd. - Ab against BM of glomeruli and alveoli
Diffuse sclerosing GN and End stage kidney
(Chronic GN)
- advanced stage of all GN
- glomerulosclerosis, sclerosis of small arteries, tubular atrophy,
interstitial fibrosis…
Extracapillary glomerulonephritis
Extracapillary glomerulonephritis
End stage kidney
End stage kidney
Pathology of uropoetic system
Acute tubulointerstitial nephritis (acute pyelonephritis) (94)
• E. coli, staphylococcuc aureus
• ascending infection – reflux of the urine into the renal pelvis and calyces –
bacteria entry into the renal parenchyma
• haematogenous infection
• abscess formation, purulent granulocytic exsudate in tubules (leukocyte
casts), purulent inflammation in the collecting tubules, interstitial tissue and
in renal pelvis
• complications – urosepsis, pyonephros, peri- & pararenal abscess…
Acute tubulointerstitial nephritis
Acute tubulointerstitial nephritis
Acute tubulointerstitial nephritis (94)
Acute tubulointerstitial nephritis (94)
PATHOLOGY OF UROGENITAL SYSTEM
Adenocarcinoma of kidney (Renal cell carcinoma, Grawitz‘ tumor) (53)
• malignant, 70 – 80% of all renal cancers
• from tubular epitelium
• hematuria, flank and vague pain, palpable abdominal mass (in less
than 10% of patients), paraneoplastic syndromes (EPO production)
• golden yellow tumour, necrosis, haemorrhage
• more histological types
• clear cells – content of glycogen and lipids (clear cell carcinoma)
Renal cell carcinoma (53)
Nephroblastoma (Wilms’ tumor) (251)
• most common solid tumor in young children (usually age before 4
years), malignant
• defect in chromosome 11 (WT1,2)
• histologically 3 elements:
- metanephric blastema (primitive embryonic nephroblastic tissue)
- immature spindled cell stroma (muscle, cartilage, bone, fat
tissue, fibrous tissue)
- immature epithelial elements (abortive tubules and glomeruli)
Pathology of uropoetic system
Nephroblastoma (Wilms’ tumor) (251)
Nephroblastoma (Wilms’ tumor) (251)
Pathology of endocrine system
Diabetes mellitus
= heterogeneous metabolic disorder characterised by hyperglycemia due to
substantially reduced or nonexists insulin secretion
1.) Type I DM (total insuline deficiency)
2.) Type II DM (relative insuline deficiency)
3.) Other types of DM
4.) Gestational DM
Complications:
- acute: diabetic ketoacidosis, nonketotic
hyperosmolar coma, hypoglycemia
- chronic: macroangiopathy,
microangiopathy (diabetic retinopathy
nefropathy), diabetic neuropathy, diabetic
foot
Pathology of endocine system
Diabetic nephropathy (159)
- increase in mesangial matrix → glomerulosclerosis
- diffuse
- nodular (Kimmelstiel - Wilson syndrome)
- sclerosis of small arteries
- Armanni/ Ebstien cells – prox. tubular cells filled with glycogen
Stage GF proteinuria BP histology
I ↑ - normal glomerular
hypertrophy
II normal - normal BM
thickening
III normal microalbumin
uria
(↑) proliferation
of
mesangium
IV ↓ proteinuria
↑
intercapillary
sclerosis *
V ↓↓
nephrotic
syndrome
↑↑
glomerulo-
sclerosis,
sclerosis of
vessels
- * diffuse type / nodular type (Kimmelstiel – Wilson´s glomerulosclerosis)
- Armani cells – glycogen filled cells of prox.tubuli
Pathology of endocrine system
Glomerulosclerosis and arteriolosclerosis (159)
calcificate
Glomerulosclerosis – hyalinisation and arteriolosclerosis (159)
Glomerulosclerosis – Kimmelstiel Wilson disease and arteriolosclerosis(159)
Pathology of endocrine system
Thyroid gland goiter
Hashimoto’s disease (tyreoiditis) (240)
- chronic lymphocytic tyreoiditis
- autoimmune disease (inhibitory TSH-R Ab, other Ab, T-cells)
- hypothyroidism
- lymphocytic infiltrate with formation of lymphoid follicles with
germinal centres
- decreased number of thyroid follicles, devoid of colloid
- oncocytes (Hurthle, Askanazy, oxyphil cells) – transformed
follicular epithelial cells
Hashimoto’s disease (240)
Hashimoto’s disease (240)
Hashimoto’s disease (240)
Pathology of endocrine system
Thyroid gland goiter
Graves - Basedow disease (70)
- autoimmune disease (TSH-R stimulating Ab)
- hyperthyroidism
- hyperplasia of folicullar cells forming papillary projections into the lumen
- depletion of colloid („moth-eaten“)
Graves - Basedow disease (70)
Graves - Basedow disease (70)
Pathology of endocrine system
Pheochromocytoma (193)
frequent in adults
• neuroendocrine tumor from chromaffin cells of the adrenal medulla
• secretes excessive amounts of catecholamines
• hypertensive crises
• benign / malignant
• sporadic / (hereditary - MEN 2A, B)
Pheochromocytoma (193)
Pheochromocytoma (193)
Pathology of endocrine system
Neuroendocrine tumor (NETs) (184)
• benign / malignant
• appendix, term.ileum, colon, intestinum, bronchus, pancreas, other..
• serotonin, kallikrein, histamine, bradykinin... „carcinoid syndrome “
Skin flushing - The skin on face and upper chest changes color from
pink to red to purple with the feeling of „heat“. Flushing episodes last
from 30 to 60 seconds. Flushing can be provoked by eating or
drinking alcohol
• Diarrhea. Frequent, watery stools accompanied by painful
abdominal cramps
• Asthma-like signs and symptoms
NET – colon (184)
NET – colon (184)
NET
gland