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RENAL DISEASES
Pathology DepartmentUniversity Surakarta for Medical Sciences
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The Nephron
Consists of the glomerulus and its attached
tubules.
The functional unit of the kidney.
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Major Renal Syndromes
Acute Nephritic Syndrome
The Nephrotic Syndrome
Rapidly Progressive Glomerulonephritis Asymptomatic Hematuria or Proteinuria
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Major Renal Syndromes (cont)
Acute Renal Failure
Urinary Tract Infection
Nephrolithiasis
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Acute Nephritic Syndrome
Sudden onset of hematuria with RBC casts and
renal failure (days - weeks)
Proteinuria (mild to moderate butNOT Nephrotic
Range)
Hypertension
Hallmark Disease: Post Streptococcal
Glomerulonephritis
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What is an
RBC cast?
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The Nephrotic Syndrome
Proteinuria (>3.5gm/day)
Hypoalbuminemia
Edema Hyperlipidema
Lipiduria
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Rapidly Progressive
Glomerulonephritis
Nephronal hematuria
Renal failure developing over weeks to months
Diffuse glomerular crescent formation.
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Asymptomatic Hematuria or
Proteinuria
Hematuria with or without RBC casts and/or
Proteinuria usually
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Acute Renal Failure
Oliguria (
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Chronic Renal Failure
Uremia
Final Common Path of All Chronic Renal
Diseases
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Urinary Tract Infection
Bacteriuria and Pyuria
Dysuria, Frequency, Urgency
Pyelonephritis or Cystitis
WBC casts = Pyelonephritis
Fever
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Nephrolithiasis
Renal stones
Renal colic - OOOUUUCCCHHH!!
Severe, Crampy Pain in the flank area
Hematuria (NotRBC casts!)
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Glomerular Diseases
An important cause of chronic renal failure
Renal Syndromes related to Glomerular Diseases
Acute Nephritic Syndrome
Nephrotic Syndrome
Rapidly Progressive Glomerulonephritis
Asymptomatic Hematuria or Proteinuria
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Glomerulus
Endothelial cells
Glomerular basement membrane (GBM)
Podocytes - Visceral Epithelial Cell
Mesangial cells and matrix
Parietal epithelium
Bowmans Capsule
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Normal Glomerulus PAS
Normal Glomerulus Silver Stain
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Normal Glomerulus Silver Stain
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Normal Glomerulus EM
GBM
Mesang
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Glomerular Basement Membrane
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Glomerular Basement Membrane
Podocytes
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Glomerular Function
Glomerular filtration
barrier
charge
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Pathogenesis of Glomerular Diseases
Immune mechanisms
Non-immune mechanisms
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Circulating Immune Complex Nephritis
Glomerulus is innocent bystander
Antigen is either endogenous or exogenous
Antigen - antibody complexes trapped in
glomeruli.
Role of complement
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Circulating Immune Complex Nephritis:
Histologic Manifestations
LM - Cellular proliferation and leukocyte
infiltration
EM - Electron dense deposits
IF - Granular deposits
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Immune Complex Nephritis
In-Situ
Antiglomerular basement membrane disease
Antibodies against fixed antigens in the GBM LM - crescents
IF - linear deposits
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Antiglomerular Basement Membrane
Antibodies
Board Hint:
Basement membrane antigen in Good Pastures -Alpha 3 chain of collagen type 4
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Heymanns Nephritis - Membranous
GN
Antigen - Megalin associated with receptor
associated protein
Discontinuous distribution
Granular IF
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Immune Complex Nephritis - Planted
Non-glomerular Antigens
Including: Cationic molecules; DNA; Bacterial
products; etc.. IF - granular pattern
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Cell Mediated Immune
Glomerulonephritis
Sensitized T-cells are thought to cause glomerular
injury
May account for GN without immune deposits
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Mediators of Immune Injury
Glomerular damage - loss of glomerular barrier
function
Manifested by proteinuria and sometimes by
reduced GFR
Complement - Leukocyte Mediated
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Complement Leukocyte Mediated
Mechanism
One Well-Established Pathway!!!
Activation of complement initiates:
Chemotaxis (C5a)
Neutrophil and monocyte infiltration
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Neutrophil Activity
Proteases
Reactive oxygen metabolites
Arachidonic acid metabolites
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