Renal Pathology

Introduction:
150gm: each kidney
1700 liters of blood filtered 180 L of G. filtrate
1.5 L of urine / day.
Kidney is a retro-peritoneal organ
Blood supply: Renal Artery & Vein
One half of kidney is sufficient reserve
kidney function: Filtration, Excretion, Secretion,
Hormone synthesis.

Kidney
Location:

Kidney Anatomy:

Renal Pathology Outline

Glomerular diseases: Glomerulonephritis
Tubular diseases: Acute tubular necrosis
interstitial diseases: Pyelonephritis
Diseases involving blood vessels: Nephrosclerosis
Cystic diseases
Tumors

Clinical Syndromes:
Nephritic syndrome.
Oliguria, Haematuria, Proteinuria, Oedema.

Nephrotic syndrome.
Gross proteinuria, hyperlipidemia,

Acute renal failure

Oliguria, loss of Kidney function - within weeks

Chronic renal failure.

Over months and years - Uremia

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

Abnormal findings
Azotemia: BUN, creatinine
Uremia: azotemia + more problems
Acute renal failure: oliguria
Chronic renal failure: prolonged uremia

Nephrotic syndrome

Nephritic syndrome

Massive proteinuria
Hypoalbuminemia

Hematuria
Oliguria

Edema
Hyperlipidemia/-uria

Azotemia
Hypertension

Glomerular diseases
Nephrotic syndrome
Minimal change disease
Focal segmental glomerulosclerosis
Membranous nephropathy
Nephritic syndrome

Post-infectious GN
IgA (immune) nephropathy

Nephrotic Syndrome
Massive proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia

Causes
Adults: systemic disease (diabetes)
Children: minimal change disease
Characterized by loss of foot processes
Good prognosis

Minimal change disease

Minimal change disease

Normal glumerular structure

Minimal change disease

Normal glomerulus

Focal Segmental Glomerulosclerosis

Primary or secondary
Some (focal) glomeruli show partial
(segmental) hyalinization
Unknown pathogenesis
Poor prognosis

Focal segmental glomerulosclerosis

Membranous Glomerulonephritis
Autoimmune reaction against unknown renal antigen
Immune complexes
Thickened GBM
Subepithelial deposits

Membranous glomerulonephritis

Nephritic Syndrome

Hematuria
Oliguria, azotemia
Hypertension

Causes
Post-infectious GN, IgA nephropathy
Immunologically-mediated
Characterized by proliferative changes and
inflammation

Post-Infectious Glomerulonephritis
Child after streptococcal throat infection
Immune complexes
Hypercellular glomeruli
Subepithelial humps

Post-infectious
glomerulonephritis

IgA Nephropathy
Common!
Child with hematuria after (URI) Upper
Respiratory Infection
IgA in mesangium
Variable prognosis

IgA nephropathy

 Tubular and interstitial diseases

Inflammatory lesions
pyelonephritis

Pyelonephritis

Invasive kidney infection

Usually ascends from UTI
Fever, flank pain
Organisms: E. coli, Proteus

Urinary Tract Infection

Women, elderly
Patients with catheters or mal-formations
Dysuria, frequency
Organisms: E. coli, Proteus

Acute pyelonephritis with abscesses

Pyelonephritis

Cellular cast

Chronic pyelonephritis

Drug-Induced Interstitial Nephritis

Antibiotics, NSAIDS
IgE and T-cell-mediated immune reaction
Fever, eosinophilia, hematuria
Patient usually recovers
Analgesic nephritis is different (bad)

Drug-induced interstitial nephritis

Acute Tubular Necrosis

The most common cause of ARF!
Reversible tubular injury
Many causes: ischemic (shock), toxic (drugs)
Most patients recover

Acute tubular
necrosis

Benign Nephrosclerosis
Found in patients with benign hypertension
Hyaline thickening of arterial walls
Leads to mild functional impairment
Rarely fatal

Benign nephrosclerosis

Malignant nephrosclerosis
Arises in malignant hypertension
Hyperplastic vessels
Ischemia of kidney
Medical emergency

Malignant Hypertension
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

Adult Polycystic Kidney Disease

Autosomal dominant
Huge kidneys full of cysts
Usually no symptoms until 30 years
Associated with brain aneurysms.

Adult polycystic kidney disease

Childhood Polycystic Kidney Disease

Autosomal recessive
Numerous small cortical cysts
Associated with liver cysts
Patients often die in infancy

Childhood polycystic kidney disease

Medullary Cystic Kidney Disease

Chronic renal failure in children
Complex inheritance
Kidneys contracted, with many cysts
Progresses to end-stage renal disease

 Tumors
Renal cell carcinoma
Bladder carcinoma

Renal Cell Carcinoma

Derived from tubular epithelium
Smoking, hypertension, cadmium exposure
Hematuria, abdominal mass, flank pain
If metastatic, 5y survival = 5%

Renal cell carcinoma

Bladder Carcinoma
Derived from transitional epithelium
Present with painless hematuria
Prognosis depends on grade and depth of invasion
Overall 5y survival = 50%

Bladder carcinoma