renal - wordpress.com · renal pathology outline 63 • derived from tubular epithelium smoking,...
TRANSCRIPT
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Kristine Krafts, M.D.
RenalPathology
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• Introductory stuff
• Glomerular diseases
• Tubular and interstitial diseases
• Diseases involving blood vessels
• Cystic diseases
• Tumors
Renal Pathology Outline
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• Introductory stuff
Renal Pathology Outline
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• Azotemia: BUN, creatinine• Uremia: azotemia + more problems• Acute renal failure: oliguria• Chronic renal failure: prolonged uremia
Introductory Stuff
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• Introductory stuff
• Glomerular diseases
Renal Pathology Outline
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• Introductory stuff
• Glomerular diseases• Nephrotic syndrome
• Minimal change disease• Membranous nephropathy
• Nephritic syndrome• Postinfectious GN• IgA nephropathy
Renal Pathology Outline
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Nephritic syndromeNephrotic syndrome
proteinuria inflamed glomerulus
• Massive proteinuria• Hypoalbuminemia• Edema• Hyperlipidemia/-uria
• Hematuria• Oliguria• Azotemia• Hypertension
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• Hematuria• Oliguria• Azotemia• Hypertension
Nephritic syndrome
• Massive proteinuria• Hypoalbuminemia• Edema• Hyperlipidemia/-uria
Nephrotic syndrome
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• Introductory stuff
• Glomerular diseases• Nephrotic syndrome
Renal Pathology Outline
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• Massive proteinuria
• Hypoalbuminemia
• Edema
• Hyperlipidemia, lipiduria
Symptoms of Nephrotic Syndrome
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• Adults: systemic disease (diabetes)
• Children: minimal change disease
• Characterized by loss of foot processes
Causes of Nephrotic Syndrome
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• Introductory stuff
• Glomerular diseases• Nephrotic syndrome
• Minimal change disease
Renal Pathology Outline
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• #1 cause of nephrotic syndrome in children
• Loss of foot processes
• Pathogenesis unknown
• Good prognosis
Minimal Change Disease
Things You Must Know
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Minimal change disease
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Normal glomerulus
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Minimal change disease
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Minimal change disease
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• Introductory stuff
• Glomerular diseases• Nephrotic syndrome
• Minimal change disease• Membranous nephropathy
Renal Pathology Outline
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• Autoimmune reaction against unknown renal antigen
• Immune complexes
• Thickened GBM
• Subepithelial deposits/spikes
Membranous Nephropathy
Things You Must Know
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Membranous nephropathy
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Membranous nephropathy
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• Introductory stuff
• Glomerular diseases• Nephrotic syndrome
• Minimal change disease• Membranous nephropathy
• Nephritic syndrome
Renal Pathology Outline
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• Hematuria
• Oliguria, azotemia
• Hypertension
Symptoms of Nephritic Syndrome
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• Post-infectious GN, IgA nephropathy
• Immunologically-mediated
• Characterized by proliferative changes and inflammation
Causes of Nephritic Syndrome
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• Introductory stuff
• Glomerular diseases• Nephrotic syndrome
• Minimal change disease• Membranous nephropathy
• Nephritic syndrome• Postinfectious GN
Renal Pathology Outline
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• Child after strep throat
• Immune complexes
• Hypercellular glomeruli
• Subepithelial humps
Post-Infectious Glomerulonephritis
Things You Must Know
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Post-infectious glomerulonephritis
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Post-infectious glomerulonephritis
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• Introductory stuff
• Glomerular diseases• Nephrotic syndrome
• Minimal change disease• Membranous nephropathy
• Nephritic syndrome• Postinfectious GN• IgA nephropathy
Renal Pathology Outline
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• Common!
• Child with hematuria after URI
• IgA in mesangium
• Variable prognosis
IgA Nephropathy
Things You Must Know
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IgA nephropathy
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• Introductory stuff
• Glomerular diseases
• Tubular and interstitial diseases• Pyelonephritis• Acute tubular necrosis
Renal Pathology Outline
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• Introductory stuff
• Glomerular diseases
• Tubular and interstitial diseases
• Pyelonephritis
Renal Pathology Outline
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• Invasive kidney infection
• Usually ascends from UTI
• Fever, flank pain
• Organisms: E. coli, Proteus
Pyelonephritis
Things You Must Know
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Acute pyelonephritis
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Acute pyelonephritis
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Cellular cast
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• Women, elderly
• Patients with catheters or malformations
• Dysuria, frequency
• Organisms: E. coli, Proteus
Urinary Tract Infection
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E. coli
uncomplicated complicated
UTI: Common Bugs
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Urinary catheter colonized by Proteus
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• Introductory stuff
• Glomerular diseases
• Tubular and interstitial diseases• Pyelonephritis
• Acute tubular necrosis
Renal Pathology Outline
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• The most common cause of acute renal failure!
• Reversible tubular injury
• Many causes: ischemic (shock), toxic (drugs)
• Most patients recover
Acute Tubular Necrosis
Things You Must Know
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Acute tubular necrosis
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Acute tubular necrosis
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• Introductory stuff
• Glomerular diseases
• Tubular and interstitial diseases
• Diseases involving blood vessels• Benign nephrosclerosis
• Malignant nephrosclerosis
Renal Pathology Outline
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• Found in patients with benign hypertension
• Hyaline thickening of arterial walls
• Leads to mild functional impairment
• Rarely fatal
Benign Nephrosclerosis
Things You Must Know
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Benign nephrosclerosis
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• Arises in malignant hypertension
• Hyperplastic vessels
• Ischemia of kidney
• Medical emergency
Malignant Nephrosclerosis
Things You Must Know
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• 5% of cases of hypertension
• Super-high blood pressure, encephalopathy, heart abnormalities
• First sign often headache, scotomas
• Decreased blood flow to kidney leads to increased renin, which leads to increased BP!
• 5y survival: 50%
Malignant Hypertension
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Malignant nephrosclerosis
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Malignant nephrosclerosis
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• Introductory stuff
• Glomerular diseases
• Tubular and interstitial diseases
• Diseases involving blood vessels
• Cystic diseases• Adult polycystic kidney disease• Childhood polycystic kidney disease
Renal Pathology Outline
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• Autosomal dominant
• Huge kidneys full of cysts
• Usually no symptoms until 30s
• Associated with brain aneurysms
Adult Polycystic Kidney Disease
Things You Must Know
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Adult polycystic kidney disease
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• Autosomal recessive
• Numerous small cortical cysts
• Associated with liver cysts
• Patients often die in infancy
Childhood Polycystic Kidney Disease
Things You Must Know
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Childhood polycystic kidney disease
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• Introductory stuff
• Glomerular diseases
• Tubular and interstitial diseases
• Diseases involving blood vessels
• Cystic diseases
• Tumors• Renal cell carcinoma• Bladder carcinoma
Renal Pathology Outline
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• Derived from tubular epithelium
• Smoking, hypertension, cadmium exposure
• Hematuria, abdominal mass, flank pain
• If metastatic, 5y survival = 5%
Renal Cell Carcinoma
Things You Must Know
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Renal cell carcinoma
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• Derived from transitional epithelium
• Presents with painless hematuria
• Prognosis depends on grade and depth of invasion
• Overall 5y survival = 50%
Bladder Carcinoma
Things You Must Know
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Bladder carcinoma
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• Introductory stuff
• Glomerular diseases
• Tubular and interstitial diseases
• Diseases involving blood vessels
• Cystic diseases
• Tumors
Renal Pathology Outline
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