PATHOLOGY OF KIDNEYS

VII. practical training 3rd year General Medicine

Normal glomerulus

1 Capillary lumen2 Basement membrane3 Podocytyes 4 Mesangial cells5 Proximal tubulus6 Bowman’s capsule7 Mesangial matrix8 Distal tubulus9 Macula densa

1

1

23

4

5

6

7

89

Capillary loops – electronogram

1

PodocytesPodocytal processus

Basement membrane

Endothelium

Mesangial cell

Mesangial matrix

Capillary lumen

Cystic kidney diseases

Cystic kidney diseases

Infantile cystosis (Microcystosis) of kidneys

Microcystosis

Vascular nephrosclerosis

Vascular nephrosclerosis

Vascular nephrosclerosis

Vascular nephrosclerosis

Classification of glomerular diseases

Primary Glomerular Diseases

Glomerulonefritis in Systemic Diseases

Glomerular Lesions in Vascular Diseases

Glomerular Lesions in Metabolic Diseases

Hereditary Nephropathies

Miscellaneous Glomerular Diseases

End Stage Kidney

Glomerular Lesions Following Transplantation

Aetiological clasification of glomerular injury

Non-immunological

hyperfiltrationBM polyanion lossBM inherited deffects ischemic

Immunological

circuluting immune complex

in situ immune complexanti-basement membrane

antibody (anti-GBM)ANCA antibodyT-cell mediated

cytotoxicity

Nomenclature of glomerular injury

• Diffuse - all glomeruli

• Focal - some glomeruli, others unaffected

• Global - the whole glomerulus

• Segmental - only part of the glomerulus

Light microscopic hanges

• Proliferative: increased cell numbers (proliferation, PNM and macrophages recruitment from the circulation)

• Membranous: BM thickening

• Membrano-proliferative: a combination of the two above features

• Crescentic: proliferation of cells lining Bowman’s capsule

Diabetic glomerulosclerosis (Kimmelstiel-Wilson)

1 hyaline deposits in mesangial matrix of glomerulus

1

Diabetic glomerulosclerosis (Kimmelstiel-Wilson)

1 hyaline globules in mesangial matrix of glomerulus2 capillaries around hyaline globules3 hyalinosis of mesangium

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23

Armani’s cells (PAS)

Endocapillary proliferative glomerulonefritis

1 Reduction of capillary lumen2 Bulge and proliferation of cellular formation of glomerulus

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2

2

2

Endocapillary proliferative glomerulonefritis

immunoflourescenc-subendothelial immune-complex deposit

1

1 Granular subendothelialdeposits on basal membrane

E Swelling endothelial cells 1 Basal membrane Stars- subendothelial deposits of immunoglobulins on basal membrane

1

Endocapillary proliferative glomerulonefritis, electronogram

Diffuse sclerozing glomerulonefritis

Diffuse sclerozing glomerulonefritis

Rapidly progressive (crescentic) glomerulonephritis

1 Extracapillary proliferation of epithelial cells of Bowman capsule and fibrin – compression of glomerular capillaries 2 Regresive alteration of glomerular capillaries

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2

2

Rapidly progressive (crescentic) glomerulonephritis

1 Basal membrane of Bowman capsule2 Fibrin3 Hyaline deposits in glomerular capillaries

1

2

3

3

3

Acute suppurative pyelonephritis

Acute suppurative pyelonephritis

Acute suppurative pyelonephritis

Chronic pyelonephritis

Chronic pyelonefritis (end stage kidney, anamnesis of prostatic hypertrophy)

Dilatated ureter

Capsule of kidney

End stage kidney

Kidney without big changes

Chronic urocystitis

Amyloid nephropathy

Amyloid nephropathy

Biliary nephrosis

Hydronephrosis

Hydronephrosis

Wilms’ tumour (nephroblastoma)

Wilms’ tumour (nephroblastoma)

11 Stromal component 2 Blastema component3 Epithelial component

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2

2

3

Nephroblastoma

Renal cell carcinoma, conventional type

tumour

Lower pole of kidney

Kidney in section

Tumour invasion inside vein in hilus

Renal cell carcinoma, clear cell type

Renal cell carcinoma, clear cell type