1. Renal Pathology

2. Renal Pathology Outline • Introduction • Glomerular diseases • Tubular and interstitial diseases • Diseases involving blood vessels • Cystic diseases • Tumors

3. Renal Pathology Outline • Introduction

5. Introduction • Functions of the kidney: • excretion of waste products • regulation of water/salt • maintenance of acid/base balance • secretion of hormones • Diseases of the kidney • glomeruli • tubules • interstitium • vessels

6. Introduction • Azotemia:  BUN, creatinine • Uremia: azotemia + more problems • Acute renal failure: oliguria • Chronic renal failure: prolonged uremia

7. Nephritic syndrome Nephrotic syndrome • Hematuria • Oliguria • Azotemia • Hypertension • Massive proteinuria • Hypoalbuminemia • Edema • Hyperlipidemia/-uria Introductory Stuff

11. Renal Pathology Outline • Introductory stuff • Glomerular diseases

13. Normal glomerulus

14. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome • Minimal change disease • Focal segmental glomerulosclerosis • Membranous nephropathy • Nephritic syndrome • Postinfectious GN • IgA nephropathy

15. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome

16. Symptoms of Nephrotic Syndrome • Massive proteinuria • Hypoalbuminemia • Edema • Hyperlipidemia, lipiduria

17. Causes of Nephrotic Syndrome • Adults: systemic disease (diabetes) • Children: minimal change disease • Characterized by loss of foot processes

18. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome • Minimal change disease

19. Minimal Change Disease • #1 cause of nephrotic syndrome in children • Loss of foot processes • Pathogenesis unknown • Good prognosis Things You Must Know

20. Minimal change disease

21. Normal glomerulus

22. Minimal change disease

23. Minimal change disease

24. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome • Minimal change disease • Focal segmental glomerulosclerosis

25. Focal Segmental Glomerulosclerosis • Primary or secondary • Some (focal) glomeruli show partial (segmental) hyalinization • Unknown pathogenesis • Poor prognosis Things You Must Know

26. Focal segmental glomerulosclerosis

27. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome • Minimal change disease • Focal segmental glomerulosclerosis • Membranous nephropathy

28. Membranous Nephropathy • Autoimmune reaction against unknown renal antigen • Immune complexes • Thickened GBM • Subepithelial deposits/spikes Things You Must Know

29. Membranous nephropathy

30. Membranous nephropathy

31. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome • Minimal change disease • Focal segmental glomerulosclerosis • Membranous nephropathy • Nephritic syndrome

32. Symptoms of Nephritic Syndrome • Hematuria • Oliguria, azotemia • Hypertension

33. Causes of Nephritic Syndrome • Post-infectious GN, IgA nephropathy • Immunologically-mediated • Characterized by proliferative changes and inflammation

34. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome • Minimal change disease • Focal segmental glomerulosclerosis • Membranous nephropathy • Nephritic syndrome • Postinfectious GN

35. Post-Infectious Glomerulonephritis • Child after strep throat • Immune complexes • Hypercellular glomeruli • Subepithelial humps Things You Must Know

36. Post-Infectious Glomerulonephritis “Sore throat, face bloat, pee coke”

37. Post-infectious glomerulonephritis

38. Post-infectious glomerulonephritis

39. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Nephrotic syndrome • Minimal change disease • Focal segmental glomerulosclerosis • Membranous nephropathy • Nephritic syndrome • Postinfectious GN • IgA nephropathy

40. IgA Nephropathy • Common! • Child with hematuria after URI • IgA in mesangium • Variable prognosis Things You Must Know

41. IgA nephropathy

42. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Tubular and interstitial diseases • Inflammatory lesions • pyelonephritis • drug-induced interstitial nephritis • Toxic/ischemic lesions • Acute tubular necrosis

43. Renal Pathology Outline • Introductory stuff • Glomerular diseases • Tubular and interstitial diseases • Inflammatory lesions • pyelonephritis

44. Pyelonephritis • Invasive kidney infection • Usually ascends from UTI • Fever, flank pain • Organisms: E. coli, Proteus Things You Must Know

45. Acute pyelonephritis with abscesses

46. Acute pyelonephritis

47. Acute pyelonephritis

48. Cellular cast

50. Urinary Tract Infection • Women, elderly • Patients with catheters or malformations • Dysuria, frequency • Organisms: E. coli, Proteus