Renal

Pathology
 Renal Pathology Outline

Lecture outline :
Introduction
Glomerular diseases •
Tubular and interstitial diseases •
Tumors

Assistant Professor Dr. Rafal Abdulrazaq •

M. B. Ch. B. F.I.C.M.PATH. •
 Introduction

-Functions of the kidney: •

excretion of waste products –
regulation of water/salt –
maintenance of acid/base –
balance
secretion of hormones- –
 kidneys serve to convert more than 1700
liters of blood per day into about 1 liter of a
highly specialized concentrated fluid called
urine( excretes the waste products of
metabolism).
The kidney can be divided into an outer
cortex and an inner medulla .
Each kidney is composed of nephrons
(functional unit of the kidney). Each nephron
consists of renal corpuscle (Each renal
corpuscle consists of a tuft of capillaries, the
glomerulus) and many tubules and ducts.
Normal glomerulus
 Renal Pathology
Glomerular diseases
Nephrotic syndrome –
Minimal change Glomerulopathy •
Focal segmental glomerulosclerosis •
Systemic disease (diabetes) •
Nephritic syndrome –
Postinfectious Glomerulonephritis (G.N.) •
IgA nephropathy •
Rapidly progressive glomerulonephritis •
 Nephrotic syndrome
characterized by: •
1-Proteinuria & hyporoteinemia •
The initial event is a derangement in the
capillary walls of the glomeruli , resulting in
increased permeability to the plasma protein.
2-Edema.
3-Hyperlipidemia. •
Nephritic Syndrome
Characterized by :
1. Hematuria
2. Oliguria
3. Hypertension
 Chronic Glomerulonephritis

• It is an important cause of end – stage renal

disease presenting as chronic renal failure .
• Classically , the kidneys are symmetrically
contracted and their surfaces are red brown and
diffusely granular .
• Micoroscopically , the feature common to all
cases is advanced scarring of the glomeruli and
Bowman’s spaces , sometimes to the point of
complete replacement or hyalinization of the
glomeruli .
Acute renal failure is dominated by oliguria or anuria
(reduced or no urine flow), with recent onset of
azotemia (is a biochemical abnormality that refers
to an elevation of the blood urea nitrogen (BUN)
and creatinine). It can result from glomerular,
interstitial, or vascular injury or acute tubular
necrosis.

Chronic renal failure, characterized by prolonged •

symptoms and signs of uremia (When azotemia
becomes associated with a constellation of clinical
signs and symptoms and biochemical
abnormalities, it is termed uremia ), is the end result
of all chronic renal parenchymal diseases
 Acute pyelonephritis
Is a common suppurative inflammation of the •
kidney and renal pelvis ,is caused by
bacterial infection, it affect the interstitial
tissue but later also the tubules .

It is an important manifestation of UTI •

(Urinary Tract Infection )which implies
involvement of the lower (cystitis ,prostatitis
,urethritis )or upper urinary tract
(pyelonephritis ) ,or both.
 Urinary Tract Infection- •

-Women, elderly •
-Patients with catheters or malformations •
-Clinically :Dysuria, frequency •
Organisms: E. coli, Proteus •
 Chronic Pyelonephritis
Morphologic entity in which predominantly
interstitial inflammation and scarring of
the renal parenchyma is associated with
grossly visible scarring and deformity of
the pelvicalyceal system
.

It can be divided into two forms :

1- chronic obstructive pyelonephritis
.
2- chronic reflux associated pyelonephritis
 Morphology
Microscopically
Uneven interstitial fibrosis and an
inflammatory infiltrate of lymphocytes ,
plasma cells and occasionally
neutrophils .
Dilation or contraction of tubules with
atrophy of lining epithelium .Many of
dilated tubules contain pink to blue ,
glassy appearing colloid cast
(thyroidization) .
Chronic Pyelonephritis
Tubulointerstitial Nephritis Induced by Drugs ◼
and Toxins

Toxins and drugs can produce renal injury in three ◼

ways:
(1) They may trigger an interstitial immunologic
reaction, exemplified by the acute hypersensitivity
nephritis e.g. methicillin
(2) they may cause acute renal failure.
(3) they may cause subtle but cumulative injury to
tubules that takes years to become manifest,
resulting in chronic renal insufficiency.
Acute Drug-Induced Interstitial Nephritis •
Occurs with penicillins ,rifampin ,thiazides •
and NSAIDs. The disease begins about 15
days after exposure to the drug and is
characterized by fever ,eosinophilia , rash
and renal abnormalities( hematuria and mild
proteinuria) . Acute renal failure with oliguria
develops in about 50% of cases, particularly
in older patients. withdrawal of the drug is
followed by recovery .
Pathogenesis: •
Many features of the disease suggest an •
immune mechanism
Morphology. •
On histologic examination, the abnormalities •
are in the interstitium, which shows edema
and infiltration by mononuclear cells,
principally lymphocytes and macrophages.
Eosinophils and neutrophils may be present
.

"Tubulitis," means the infiltration of tubules by

lymphocytes, is common. Variable degrees of
tubular necrosis and regeneration are
present. The glomeruli are normal except in
some cases
Drug-induced interstitial nephritis
Analgesic Nephropathy •
This is a form of chronic renal disease •
caused by excessive intake of analgesic
mixtures (e.g. aspirin, acetaminophen ) and
characterized morphologically by chronic
tubulointerstitial nephritis with renal papillary
necrosis. Thus, the papillary damage may be
due to a combination of direct toxic effects of
drug metabolites and ischemic injury to both
tubular cells and vessels.
A small percentage of patients with analgesic •
nephropathy develop transitional papillary
carcinoma of the renal pelvis
 Analgesic nephropathy
oss ,The brownish necrotic papilla, transformed to a necrotic,
structureless mass fills the pelvis.
B, Microscopic view. Note the fibrosis in the medulla
WILMS' TUMOR
It is seen primarily in infants, 50% of the
cases occurring before the age of 3
years.
The classic clinical presentation of Wilms'
tumor is in the form of an abdominal mass
felt by the mother when handling the
child
Microscopically, three major components
are identified: undifferentiated blastema,
mesenchymal (stromal) tissue, and
epithelial tissue
Wilms’ Tumor
Renal Cell Carcinoma

-Derived from tubular epithelium

-Risk factors :Smoking, hypertension, ◼
cadmium exposure
-Clinically :Hematuria, abdominal ◼
mass, flank pain
RENAL CELL CARCINOMA
Clear cell carcinoma(the most common form) are
usually solitary & large , when symptomatic 3-15
cm in diameter . They may arise any where in the
cortex.
The cut surface is yellow, orange to grey–white with
prominent areas of hemorrhage , either fresh or
old .

Microscopically, In clear cell carcinoma the

tumor cells may appear almost vacuolated
(lipid laden) or clear , the nuclei small & round .
RENAL CELL CARCINOMA
Renal cell carcinoma
Clear cell carcinoma