pathology of the urinary system (kidney, urinary tract, bladder)

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Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

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Page 1: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Pathology

of the

Urinary System

(Kidney, Urinary Tract, Bladder)

Page 2: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Plan:

Lecture 1: Recap of anatomy and physiology, clinical aspects of renal disease, pathogenesis of glomerulonephritis

Lecture 2:Morphologic expressions of glomerular injury, primary glomerular diseases

Lecture 3:Primary glomerular disease

Page 3: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Introduction.

• Weight 150 g

• Cortex (1.5 cm) and

medulla

• Renal pelvis - 2 to 3

major calyces - each

3-4 minor calyces.

Page 4: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Filters about 1700 L of blood

to prepare 1 L of urine

Page 5: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Anatomical structure of parenchyma ..

Lobe

Lobule

Cortex

Medulla

Page 6: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Anatomical structure of parenchyma .

Lobules

Cortex

o Columns of

Bertin

Medulla (O , I)

o Pyramid

o Papilla

Page 7: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

The Cortex

Labyrinth

Medullary rays

Page 8: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Vasculature

Renal artery

- anterior and posterior br ---- interlobar ---- arcuate ---

interlobular ---- afferent arteriole ---- glomerulus ---- efferent

arteriole ---- peritubular capillaries ---- vasa recta ---- venous

vasa recta ---- renal vein

Page 9: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Vascular structure of parenchyma

Page 10: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Renal vasculature

• Arteries are end arteries• Glomerular diseases can compromise

vascular supply to other components• Medulla is relatively avascular and

vulnerable to ischemia• Cortex is more vulnerable to hypertensive

changes

Page 11: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

The Nephron

Page 12: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

(Pathology) Compartments

• Glomeruli

• Tubules

• Interstitium

• Blood vessels

Page 13: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)
Page 14: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Glomerulus

• Formation• Components• Structure

Page 15: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Glomerulus

• Formation• Components• Structure

• Bowmans capsule• Parietal epithelial cells• Visceral epithelial cells• Basement membrane• Endothelial cells• Mesangial cells• Mesangial matrix

Page 16: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Glomerulus

• Formation• Components• Structure

Bowmans capsuleParietal epithelial cellsVisceral epithelial cellsBasement membraneEndothelial cellsMesangial cellsMesangial matrix

Page 17: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Glomerulus

• Formation• Components• Structure

Filtration membrane

• fenestrated endothelial cells (70-100

nm);

• glomerular Basement Membrane

• visceral epithelial cells -podocytes

(20-30 nm)

Page 18: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Glomerulus

• Formation• Components• Structure

• Glomerular basement membrane: - Thick inner lamina densa - Lamina rara externa and interna.

Collagen IV, laminin, polyanionic proteoglycans, intermediate filaments, other glycoproteins.

Filtration is governed by size and charge.

Page 19: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

The Glomerulus

Page 20: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

The Glomerulus

Page 21: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Basement Membrane: (LM)

Identified better using special

stains such as

PAS (Per-iodic acid Schiff)

Silver impregation methods

Invests capillaries incompletely,

and is continuous with capsular

BM

Page 22: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Juxta-glomerular apparatus

• JG cells of afferent arteriole,

• macula densa of DCT,

• Lacis cells of mesangium

Principal source of renin

Page 23: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Tubules and interstitium

• Proximal tubules: Rich in mitochondria, microvilli, canaliculi

and interdigitations - Major site for re-absorption of water,

glucose, sodium, potassium, phosphate, proteins, amino acids.

Vulnerable to vascular and toxic injury.

Page 24: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

.

.

.

Histology of PCT

Page 25: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Proximal tubules:

Abundant granular cytoplasm

Distal tubules:

Cuboidal cells

Page 26: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Loops of

Henle,

and

Collecting

Ducts

Page 27: Pathology of the Urinary System (Kidney, Urinary Tract, Bladder)

Interstitium:

Scanty in the cortex and outer medulla

More abundant in inner medulla