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Pathology of the Kidney and Its Collecting System

Pathology of the Kidney and Its Collecting System. Dr. Francisco G. La Rosa Francisco.LaRosa@UCHSC.edu. Home Page. Embriology of the Kidney and Collecting System. Home Page. Anatomy of the Kidney. Home Page. KIDNEY

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Pathology of the Kidney and Its Collecting System

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  1. Pathology of the Kidney and Its Collecting System Dr. Francisco G. La RosaFrancisco.LaRosa@UCHSC.edu Home Page

  2. Embriology of the Kidney and Collecting System Home Page

  3. Anatomy of the Kidney Home Page

  4. KIDNEY • Functions:Excretion of waste productsRegulation of water and saltMaintenance of acid balanceSecretion of hormones and by-products • Structures and Diseases:Glomeruli (immune damage)Tubuli (toxic or infections)Interstitium (toxic or infections)Blood vessels (metabolic) Home Page

  5. CLINICAL MANIFESTATIONSOF RENAL DISEASE • Syndromes: • Acute Nephritic syndromeNephrotic syndromeAsymptomatic hematuria Asymptomatic proteinuriaAcute renal failureChronic renal failureUrinary tract infection (UTI)NephrolitiasisTumors Home Page

  6. GLOMERULAR DISEASES Primary GlomerulonephritisAcute diffuse proliferative GNRapidly progressive GNMembranous GNLipoid nephrosis (minimal change disease)Focal segmental glomerulosclerosisMembranoproliferative GNIgA NephropathyChronic GNSecondary (Systemic) DiseasesSystemic lupus erythematosusDiabetes mellitusAmyloidosisGoodpasture’s syndromePolyarteritis nodosaWagener’s granulomatosisHenoch-Scholein purpuraBacterial endocarditis Hereditary DisordersAlport’s syndromeFabry’s disease Home Page

  7. Ischemia / Toxins Tubular Injury Intrarenal Vasoconstriction (Increased Endothelin; decreased NO) Tubule Obstruction Back- Leakage Reduced Glomerular Plasma Flow Reduced O2 delivery to Outer Medulla Increased Intratubular Pressure ? Direct Glomerular Effect Reduced GFR  Oliguria Acute Renal Failure Home Page

  8. Schematic Representation of a Glomerular Lobe Home Page

  9. Low-power electron micrograph of rat glomerulus: CL, capillary lumen; End, endothelium Mes, mesangium; B, basement membrane; Ep, visceral epithelial cells with foot processes; US, urinary space. Home Page

  10. Antibody-mediated glomerular injury: (A) Circulating Ag-Ab complexes, (B) Anti-basement membrane, (C) In situ Ag-Ab complexes. Home Page

  11. Albumin Epithelial cell injury and destruction of the basement membraneas a result of immune complex in the glomerulus.Normally, the basement cell membrane does not filter large molecules such asalbumin (70,000 kD), which is present in urine if the membrane is damaged. Home Page

  12. Oxidants Proteases EicosanoidsCytokines Growth Factors Nitric Oxide Others Mediators of immune glomerular injury. Home Page

  13. NEPHROTIC SYNDROME • Proteinuria (>3.5 g/day) • General edema • Hypoalbuminemia (<3gr/dL) • Hyperlipidemia • Lipiduria Home Page

  14. Home Page

  15. Lipoid Nephrosis (A and C) and Membranous Glomerulonephritis (B and D). Home Page

  16. Epithelial Cells & Podocytes Antigen-Antibody Deposits Basement Membrane Endothelial Cells Capillary Lumen Urinary Space Mesangium Nephrotic syndrome: Home Page

  17. IgA Nephropathy Focal mesangialproliferativeglomerulonephritis Immunofluorescence in the glomeruli:IgG +, IgA +++ (shown here), IgM Negative,and C3 ++. IgA Home Page

  18. Epithelial Cells & Podocytes Antigen-Antibody Deposits Basement Membrane Endothelial Cells Capillary Lumen Urinary Space Mesangium IgA Nephropathy Home Page

  19. Acute Nephritic Syndrome C3 Home Page

  20. Epithelial Cells & Podocytes Antigen-Antibody Deposits Basement Membrane Endothelial Cells Capillary Lumen Urinary Space Mesangium Acute Nephritic Syndrome Home Page

  21. Cast Proliferation, glomerular crescents, necrosis IgG linear pattern Fibrinogen Acute nephritic syndrome Goodpasture's syndrome Home Page

  22. Membranoproliferative Glomerulonephritis (MGN): Mesangial proliferation, basement membrane • thickening, leukocyte infiltration and accentuation of lobular architecture. • (B) Type I and Type II MGN . Home Page

  23. IgG Proliferative Glomerulonephritis Systemic Lupus Home Page

  24. Tubular and InterstitialDiseases Tubulointerstitial NephritisAcute pyelonephritisChronic pyelonephritis Drug-Induced interstitial nephritis Acute tubular necrosis Home Page

  25. Pathways of Renal Infection Home Page

  26. Acute Cystitis Home Page

  27. Hydronephrosis andchronic obstructive pyelonephritis Home Page

  28. Chronic pyelonephritis Home Page

  29. Vascular Diseases Benign nephrosclerosis Malignant hypertension/Malignant nephrosclerosis Thrombotic microangiopathies Home Page

  30. Acute Renal Infarct Home Page

  31. Malignant hypertension leads tofibrinoid necrosis of small arteries.The damage to the arteries leads toformation of pink fibrin-- hence the term "fibrinoid". Thickening of the arterial wallwith malignant hypertension produces a hyperplastic arteriolitis.The arteriole has an "onion skin" appearance Home Page

  32. CONTINUE IN LECTURE 2 Home Page

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