Renal - WordPress.com · Renal Pathology Outline 63 • Derived from tubular epithelium Smoking, hypertension, cadmium exposure • Hematuria, abdominal mass, flank pain • If metastatic,

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

Introductory Stuff

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• Glomerular diseases• Nephrotic syndrome

• Minimal change disease• Membranous nephropathy

• Nephritic syndrome• Postinfectious GN• IgA nephropathy


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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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• 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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• Minimal change disease


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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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• Autoimmune reaction against unknown renal antigen

• Immune complexes

• Thickened GBM

• Subepithelial deposits/spikes

Membranous Nephropathy


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Membranous nephropathy

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Membranous nephropathy

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• Nephritic syndrome


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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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• Nephritic syndrome• Postinfectious GN


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• Child after strep throat

• Immune complexes

• Hypercellular glomeruli

• Subepithelial humps

Post-Infectious Glomerulonephritis


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Post-infectious glomerulonephritis

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Post-infectious glomerulonephritis

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• Nephritic syndrome• Postinfectious GN• IgA nephropathy


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• Common!

• Child with hematuria after URI

• IgA in mesangium

• Variable prognosis

IgA Nephropathy


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IgA nephropathy

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• Tubular and interstitial diseases• Pyelonephritis• Acute tubular necrosis


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• Pyelonephritis


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• Invasive kidney infection

• Usually ascends from UTI

• Fever, flank pain

• Organisms: E. coli, Proteus

Pyelonephritis


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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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• Tubular and interstitial diseases• Pyelonephritis

• Acute tubular necrosis


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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


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Acute tubular necrosis

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Acute tubular necrosis

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• Diseases involving blood vessels• Benign nephrosclerosis

• Malignant nephrosclerosis


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• Found in patients with benign hypertension

• Hyaline thickening of arterial walls

• Leads to mild functional impairment

• Rarely fatal

Benign Nephrosclerosis


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Benign nephrosclerosis

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• Arises in malignant hypertension

• Hyperplastic vessels

• Ischemia of kidney

• Medical emergency

Malignant Nephrosclerosis


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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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• Cystic diseases• Adult polycystic kidney disease• Childhood polycystic kidney disease


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• Autosomal dominant

• Huge kidneys full of cysts

• Usually no symptoms until 30s

• Associated with brain aneurysms

Adult Polycystic Kidney Disease


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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


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Childhood polycystic kidney disease

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• Cystic diseases

• Tumors• Renal cell carcinoma• Bladder carcinoma


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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


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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


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Bladder carcinoma

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• Cystic diseases

• Tumors


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Renal - WordPress.com · Renal Pathology Outline 63 • Derived from tubular epithelium Smoking, hypertension, cadmium exposure • Hematuria, abdominal mass, flank pain • If metastatic,