Pathology Ch 19 Part 2

Front 1

Inherited, Congenital & Development Disease

Back 1

•Simple Cyst - Common

•Hereditary Polycystic kidney disease

(Genetic).

°Adult Polycystic Disease

-Autosomal Dominant, 10% of Chronic Renal Failure, Sx after 30y.o.

°Childhood Polycystic Disease

-Autosomal Recessive, perinatal death or liver cirrhosis (cysts) if survive.

Front 2

Inherited, Congenital & Development Disease

Back 2

•Renal Dysplasia - another Cystic disease

-In utero obstruction of urinary outflow (ureter). Increased pressure causes failure of glomeruli to develop, kidney enlarges & tubule become cysts.

Front 3

Inherited, Congenital & Development Disease

Horseshoe Kidney

Back 3

•Abnormal embryogenesis

-No clinical consequences

Front 4

The Initiation and Progression of Glomerular Disease

Back 4

•Autoimmune reactions in glomerulnephritis

A. Circulating immune complexes formed elsewhere are deposited on the glomerular basement membrane (GBM)

•All Primary Glomerular Disease is Autoimmune

Front 5

The Initiation and Progression of Glomerular Disease

Back 5

•Autoimmune reactions in glomerulnephritis

B. Antibody Attachment (attack) to native antigens on the glomerular basement membrane

•All primary Glomerular Disease is Autoimmune

Front 6

Types of Glomerulnephritis

("itis" = inflammation)

Back 6

•Post-Streptococcal glomerulnephritis: Autoimmune, presents as acute nephrotic syndrome incl. Hematuria, HTN, incr. BUN and Cr. Antigen-Antibody deposit in glomerulus.

Front 7

Types of Glomerulnephritis ("itis" = inflammation)

Back 7

•Rapidly progressive glomerulnephritis: Autoimmune, arcs (crescent) of cells (masses) form in Bowman's space and collapse glomerulus

Front 8

Types of Glomerulnephritis ("itis" = inflammation)

Back 8

•Membranous glomerulnephritis: Autoimmune deposits thicken basement membrane of Glomerulus.

Front 9

Types of Glomerulnephritis ("itis" = inflammation)

Back 9

•Minimal change glomerulnephritis: Glomerular epithelial cells basement membrane of glomerulus.

Front 10

Types of Glomerulnephritis ("itis" = inflammation)

Back 10

•IgA glomerulnephritis: Antibodies deposit in support (mesangial) cells of glomerulus, most common glomerulnephritis worldwide

Front 11

Types of Glomerulnephritis ("itis" = inflammation)

Back 11

•Chronic glomerulnephritis: Long term renal failure or "Smoldering" Autoimmune state, seen finally as occult protein in urine, fatigue d/t anemia. 50% of patients renal Dialysis carry this diagnosis.

Front 12

Glomerulnephritis

Crescentic Glomerulnephritis

Back 12

•Crescent of epithelial cells proliferates along the parietal rim of the Glomerular space and obliterates the glomerulus.

•Crescentic glomerulnephritis is an anatomic finding in progressively worsening glomerulnephritis of many types.

Front 13

Secondary Glomerular Disease / Disease of Renal Vasculature

Back 13

•Secondary Glomerular Disease

°Diabetic glomerulosclerosis

-Most common cause of renal failure in U.S.

Front 14

Secondary Glomerular Disease / Disease of Renal Vasculature

Back 14

•Secondary Glomerular Disease

°Renal ablation glomerulopathy

-Damage to 1/3 - 1/2 of glomeruli increases workload on other glomeruli & burns out (end - stage contracted kidney)

Front 15

Disease if Renal Vasculature

Malignant Nephrosclerosis

(Very High BP, Vicious Cycle)

Back 15

•The Hallmark lesion is Onionskin Hyperplasia of the renal arteriole

• >160/110 mmHg

Front 16

Disease if Renal Vasculature

Malignant Nephrosclerosis(Very High BP, Vicious Cycle)

Back 16

•Renal failure, vascular stress (MI, CHF), increased Intracranial Pressure (Seizure, Headache, Nausea, Vomit, Visual Impairment

•25% die within 5 years

Front 17

Disease of Renal Vasculature

Back 17

•Renovascual Hypertension - Increased BP due to renal ischemia (atherosclerosis of renal artery)

•Tx - removal of effected kidney

Front 18

Acute Tubular Necrosis

Back 18

•The paleness of the renal cortex is caused by necrotic tubular epithelium.

•The pyramids are congested.

•Note: Glomeruli are spared and tube epithelial cells re-grow over few wk if basement membrane is still intact.

•Period of small then large urine volume? Lack of water Reabsorption.

Front 19

Tubulointerstitial Nephritis

Back 19

•End - Result of most renal disease.

•The interstitium is filled with chronic inflammatory cells (Lymphocytes) & Fibrosis.

•Tubules are dilated and filled with Protein Casts; tubular epithelium is atrophic

Front 20

Obstruction, Reflux, and Stasis

Back 20

•Obstruction and reflux encourage Infection and stone formation and contribute directly to hydronephrosis and tubulointerstitial nephritis

-Damage not always d/t Infection. (Lack of ureteral peristalsis, reflux into ureter

-Urinary tract health needs unobstructed urine flow

Front 21

Obstruction, Reflux, and Stasis

Hydronephrosis

Back 21

•The pelvis and calyces are markedly dilated and the cortex is very thin, reflecting loss of functional tissue.

Front 22

Obstruction, Reflux, and Stasis

Back 22

•Congenital incompetent ureterovesical junctions.

•Urinary reflux has produced dilated renal pelvises and ureters

Front 23

Acute Pyelonephritis: Urinary Tract Infection

Back 23

•Multiple small abscesses are present. The ureters are normal.

•Most acute Pyelonephritis is caused by ascending Infection by Escherichia coli and other fecal bacteria that ascend to the kidney from the bladder

Front 24

Acute Pyelonephritis: Urinary Tract Infection

Back 24

•Acute Pyelonephritis:

•Symptoms

-Pain & Fever , Neutrophilia, pyuria, cystitis, dysuria, possible sepsis

•Antibiotics usually curative

Front 25

Chronic Pyelonephritis: Urinary Tract Infection

Back 25

1. The presence or absence of bacteria in urine is not helpful in diagnosis

2. Often associated with obstruction or reflux

3. May be asymptomatic for long time

Front 26

Chronic Pyelonephritis: Urinary Tract Infection

Back 26

4. May be characterized by repeated episodes of fever

5. Responsible for about 10% of patients on chronic dialysis;

6. One of the main causes of chronic tubulointerstitial nephritis & Chronic Renal Failure

Front 27

Chronic Pyelonephritis: Urinary Tract Infection

Back 27

•Symptoms:

-Flank Pain

-Dysuria

-Pyuria

•Shrinks & Scars Kidney, Dilates renal pelvis & calyx, thin cortex.

Front 28

Renal Stones: Nephrolithiasis (Calculi)

Back 28

•Urinary stones often present with urinary bleeding (hematuria) or flank pain (renalolic)

•Stones predispose to obstruction and Infection and chronic tubulointerstitial nephritis

•Affect 5% of population

Front 29

Renal Stones: Nephrolithiasis (Calculi)

Back 29

•Calcium stones (75%)

-Occur in people with high urinary calcium (hypercalciuria). Blood calcium is normal

-Another group of pateints are those with high blood levels of calcium (Hypercalcemia; Hyperparathyroidism).

Front 30

Renal Stones: Nephrolithiasis (Calculi)

Back 30

•Infection Stones (15%)

-Bacteria change pH to alkaline precipitating a magnesium stone

•Uric Acid Stones (5%)

-25% of patients with gout

Front 31

Renal Stones

Back 31

•Staghorn Calculus:

Large stone in renal pelvis that cannot pass will remain in renal pelvis & mold into the shape of the calyces

Front 32

Tumors of the Kidney

Back 32

•Two most important Malignancies of the kidney:

1. Renal cell carcinoma (90%), tubular epithelium

1. 5 yr survival rate: 50% if malignant, 75% in non-metastic; 15% if renal vein invaded; 1/3 linked to tobacco use

Front 33

Tumors of the Kidney

Back 33

2. Transitional cell (Renal pelvis) carcinoma, pelvis epithelium. (10%)

1. 5 yr survival rate = 66%

2. Tx = Nephrectomy

Front 34

Tumors of the Kidney

Back 34

•Renal cell carcinoma (Tubular Epithelium)

°Renal vein and vena cava are filled with invasive tumor.

-Poor 5 yr survival here (15%)

-Can extend into inferior vena cava, metastasizing to lung or bone