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Diseases of urinary Diseases of urinary systemsystem
Zhang HongyingZhang Hongying
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How to learn systemic How to learn systemic pathology (pathology of pathology (pathology of urinary system) ?urinary system) ?
basic science (anatomy, histology,basic science (anatomy, histology, physiology, immunology…)physiology, immunology…)
general pathologygeneral pathology systemic pathologysystemic pathology clinic practiceclinic practice*correlations between structural and functi*correlations between structural and functi
onal changes (clinicopathologic correlatioonal changes (clinicopathologic correlations) ns)
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Functions of the kidneysFunctions of the kidneys
Eliminating metabolic waste producEliminating metabolic waste productsts
Regulating fluid and electrolyte balaRegulating fluid and electrolyte balancence
Influencing acid-base balanceInfluencing acid-base balance Secreting hormones (prostaglandins, Secreting hormones (prostaglandins,
erythropoietin, 1,25-dihydroxycholeerythropoietin, 1,25-dihydroxycholecalciferol, renin)calciferol, renin)
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The nephron
The main functional unit of the kidney
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Normal glomerulus
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OutlineOutline GlomerulonephritisGlomerulonephritis Tubulointerstitial nephritisTubulointerstitial nephritis Diseases of the lower urinary Diseases of the lower urinary
tracttract Tumors of urinary systemTumors of urinary system
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Etiology of glomerular diseaEtiology of glomerular diseasesses
Primary(majority):disease process aPrimary(majority):disease process appears to start within the glomerulusppears to start within the glomerulus
Secondary:disease process is secondSecondary:disease process is secondary to systemic disease (SLE, vasculaary to systemic disease (SLE, vascular diseases, diabetes mellitus)r diseases, diabetes mellitus)
Hereditary:congenital diseases ( FabHereditary:congenital diseases ( Fabry’s disease)ry’s disease)
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Primary glomerulonephritiPrimary glomerulonephritiss
kidney is the kidney is the onlyonly or or predominantpredominant organ organ
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Mechanism of glomerular iMechanism of glomerular injurynjury
Circulating immune complex Circulating immune complex nephritisnephritis
immune complex nephritis in immune complex nephritis in situsitu
Cell-mediated immunityCell-mediated immunity Other mechanismsOther mechanisms
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Granular pattern
Immunofluorescence microscopy
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Linear pattern
Immunofluorescence microscopy
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Mechanism of glomerular iMechanism of glomerular injurynjury
Circulating immune complex Circulating immune complex nephritisnephritis
immune complex nephritis in immune complex nephritis in situsitu
Cell-mediated immunityCell-mediated immunity Other mechanismsOther mechanisms
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Steps in diagnoses of glomeSteps in diagnoses of glomerular lesionsrular lesions
Clinical presentationClinical presentation Renal biopsyRenal biopsy
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Clinical manifestationsClinical manifestations Hematuria (red blood cells in urine)Hematuria (red blood cells in urine) Proteinuria (protein lost in urine) Proteinuria (protein lost in urine) Oliguria or anuria (no urine flow)Oliguria or anuria (no urine flow) Edema Edema Hypertension Hypertension Urinary casts (cell casts, granular casts, hUrinary casts (cell casts, granular casts, h
yaline casts)yaline casts) Azotemia (waste products accumulation)Azotemia (waste products accumulation) Uremia (with autotoxication symptom)Uremia (with autotoxication symptom)
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Clinical presentationsClinical presentations
Acute nephritic syndrome: acute oAcute nephritic syndrome: acute onset, blood pressurenset, blood pressure ,, hematuria,hematuria, proteinuria, edema, azotemia proteinuria, edema, azotemia
Rapidly progressive nephritic syndRapidly progressive nephritic syndrome: abrupt or insidious onset of rome: abrupt or insidious onset of hematuria, proteinuria, anemia anhematuria, proteinuria, anemia andd rapidly progressing renal failurerapidly progressing renal failure
Glomerulonephritis
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Clinical presentationsClinical presentations Nephrotic syndrome: heavy protNephrotic syndrome: heavy prot
einuria, hypoalbuminemia, seveeinuria, hypoalbuminemia, sever edema, hyperlipidemia and lipir edema, hyperlipidemia and lipiduriaduria
Chronic nephritic syndrome: sloChronic nephritic syndrome: slowly developing renal failure accwly developing renal failure accompanied by proteinuria, hematompanied by proteinuria, hematuria hypertension and uremiauria hypertension and uremia
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Key factsKey factsrenal failurerenal failure
Two renal syndromes of Two renal syndromes of total total renal failurenal failure ( acute and chronic renal failure)re ( acute and chronic renal failure)
Two main syndromes of Two main syndromes of partial partial renal failrenal failure (nephritic syndrome and nephrotic sure (nephritic syndrome and nephrotic syndrome)yndrome)
Chronic renal failure is Chronic renal failure is irreversibleirreversible, as it , as it is caused by permanent destruction of neis caused by permanent destruction of nephronsphrons
Acute renal failure sometimes recovers Acute renal failure sometimes recovers when the damaging stimulus resolveswhen the damaging stimulus resolves
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The renal biopsyThe renal biopsy
Histological examinationHistological examination Immunofluorescence examinationImmunofluorescence examination Electron microscopic examinationElectron microscopic examination
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The renal biopsyThe renal biopsy
Histological examinationHistological examination Immunofluorescence examinationImmunofluorescence examination Electron microscopic examinationElectron microscopic examination
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Primary glomerulonephritPrimary glomerulonephritisis
Acute diffuse proliferative glomerulonephritAcute diffuse proliferative glomerulonephritisis
Crescentic glomerulonephritisCrescentic glomerulonephritis Membranous glomerulonephritisMembranous glomerulonephritis Lipoid nephrosisLipoid nephrosis Focal segmental glomerulosclerosisFocal segmental glomerulosclerosis Membranoproliferative glomerulonephritisMembranoproliferative glomerulonephritis IgA nephropathyIgA nephropathy Chronic glomerulonephritisChronic glomerulonephritis
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Diffuse proliferative glomDiffuse proliferative glomerulonephritiserulonephritis
Diffuse, global, acute inflammation Diffuse, global, acute inflammation of glomeruli is caused by the deposiof glomeruli is caused by the deposition of immune complexes in glometion of immune complexes in glomeruli, stimulated by a preceding inferuli, stimulated by a preceding infectionction
Children are more commonly affectChildren are more commonly affecteded
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EtiologyEtiology
Poststreptococcal (most common): oPoststreptococcal (most common): onset is 1-2 weeks after a primary infenset is 1-2 weeks after a primary infection with ction with -hemolytic streptococci o-hemolytic streptococci of group Af group A
Non-streptococcal(less common): a rNon-streptococcal(less common): a range of bacterial, viral and protozoal ange of bacterial, viral and protozoal infectionsinfections
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Morphology
Gross examination
Swollen with scattered petechia
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Histologic featuresHistologic features
Endothelial cells proliferatiEndothelial cells proliferationon
Mesangial cells proliferatioMesangial cells proliferationn
Neutrophils infiltrationNeutrophils infiltration
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Normal glomerulus
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Post-streptococcal glomerulonephritis
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ImmunofluorescenceGranular deposits
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Subepithelial “lumps” immune complexes deposition
Electron microscopy
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Clinical featuresClinical features Systemic symptomsSystemic symptoms Acute nephritic syndromeAcute nephritic syndrome
Acute onset
Oliguria
Edema
Hypertension
Hematuria
Azotemia
Injures of the capillary wall
GFR decrease
Fluid retention
Fluid retention, renin increase
waste products increase
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KEY FACTS:KEY FACTS:Diffuse proliferative glomerulonephritDiffuse proliferative glomerulonephrit
isis Caused by immune complexes in glomeCaused by immune complexes in glome
rulus, often after streptococcal infectiorulus, often after streptococcal infectionn
Causes nephritic syndrome, with prolifCauses nephritic syndrome, with proliferation of endothelium and mesangium eration of endothelium and mesangium and recruitment of neutrophilisand recruitment of neutrophilis
Most cases recover, but a minority may Most cases recover, but a minority may rapidly progress to renal failure or slowrapidly progress to renal failure or slowly develop chronic renal failurely develop chronic renal failure
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Main types of glomerulonephritisMain types of glomerulonephritis
Acute proliferative(poststreptococcaAcute proliferative(poststreptococcal, postinfectious)glomerulonephritisl, postinfectious)glomerulonephritis
Rapidly progressive (cresentic) glomRapidly progressive (cresentic) glomerulonephritiserulonephritis
Chronic glomerulonephritisChronic glomerulonephritis
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Rapidly progressive glomerulonephrits Rapidly progressive glomerulonephrits (RPGN; crescentic glomerulonephritis)(RPGN; crescentic glomerulonephritis)
RPGN is a manifestation of severe glomeruRPGN is a manifestation of severe glomerular injury characterized by the formation lar injury characterized by the formation of of crescent-shaped massescrescent-shaped masses within the Bow within the Bowman’s spaceman’s space
RPGN occurs in a small percentage of patiRPGN occurs in a small percentage of patients with poststreptococcal glomerulonepents with poststreptococcal glomerulonephritis, but can also be associated with manhritis, but can also be associated with many other forms of glomerular damage y other forms of glomerular damage
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PathogenesisPathogenesis
Type Type I RPGN (12%): anti-GBM antibodies ( I RPGN (12%): anti-GBM antibodies ( special type: Goodpasture syndrome) special type: Goodpasture syndrome)
Type Type II RPGN (44%): immune complex-meII RPGN (44%): immune complex-mediated disorderdiated disorder
Type Type III RPGN (44%): pauci-immune compIII RPGN (44%): pauci-immune complexeslexes
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Crescentic glomerulonephritis
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Histological featuresHistological features
The characteristic is the presense The characteristic is the presense of of crescentscrescents in in most of the glomermost of the glomeruli (>50%)uli (>50%)
The crescents lining Bowman’s cThe crescents lining Bowman’s capsule are composed of a mixture apsule are composed of a mixture of epithelial cells and macrophageof epithelial cells and macrophages proliferatings proliferating
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Basement membrane destruction
Cresentic glomerulonephritis
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Cresentic glomerulonephritis
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Cresentic glomerulonephritis
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Crescentic glomerulonephritisCrescent
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Cresentic glomerulonephritis
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Goodpasture syndrome
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Clinical featuresClinical features
RPGN is characterized by rapid anRPGN is characterized by rapid and progressive loss of renal functiod progressive loss of renal function associated with sever n associated with sever oliguriaoliguria ev even en anuriaanuria
Prognosis is poor Prognosis is poor
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Main patterns of glomerulonephritisMain patterns of glomerulonephritis
Acute proliferative(poststreptococcaAcute proliferative(poststreptococcal, postinfectious)glomerulonephritisl, postinfectious)glomerulonephritis
Rapidly progressive (cresentic) glomRapidly progressive (cresentic) glomerulonephritis erulonephritis
Chronic glomerulonephritisChronic glomerulonephritis
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Chronic glomerulonephrChronic glomerulonephritisitis
end stage kidneyend stage kidney It may be caused by many It may be caused by many
diseasesdiseases
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MorphologyMorphology
Macroscopically, affected kidneys arMacroscopically, affected kidneys are small and there is graularity of extee small and there is graularity of external surface (symmetrically contractrnal surface (symmetrically contracted)ed)
Microscopically, there is fibrosis, hyMicroscopically, there is fibrosis, hyalinization of glomeruli, tubular atroalinization of glomeruli, tubular atrophy and interstitial fibrosisphy and interstitial fibrosis
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Chronic glomerulonephritis
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Chronic renal failure
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End stage kidney
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Clinical featuresClinical features Chronic glomerulonephritis develops iChronic glomerulonephritis develops i
nsidiouslynsidiously Chronic glomerulonephritis is charactChronic glomerulonephritis is charact
erized by chronic nephritic syndromeerized by chronic nephritic syndrome
Hypertension
Proteinuria
Anemia
Azotemia
Uremia
Edema
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Uremic fibrinous pericarditis
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Required reading Suggested reading
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Case studyCase study
A 13-year-old girl who is brought by A 13-year-old girl who is brought by her parents because she had become her parents because she had become lethargic and her face appeared lethargic and her face appeared swollen, particularly around her swollen, particularly around her eyes. On enquiry, she had recently eyes. On enquiry, she had recently recovered from a flu-like illness. As recovered from a flu-like illness. As part of routine examination her part of routine examination her urine is tested with a dip-stick and is urine is tested with a dip-stick and is found that to contain both protein found that to contain both protein and blood. and blood.
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Case studyCase study
She is also noted to have a mildly raisShe is also noted to have a mildly raised blood pressure. The patient is refeed blood pressure. The patient is referred to hospital where she is found trred to hospital where she is found to have urea and creatinine together o have urea and creatinine together with a reduced urine output. Renal bwith a reduced urine output. Renal biopsy is performed.iopsy is performed.
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Histology Histology
The histology report reveals hyperceThe histology report reveals hypercellularity of glomeruli with neutrophilllularity of glomeruli with neutrophils in capillary lumina. Granular deposs in capillary lumina. Granular deposition of IgG, C1q and C3 are seen in tition of IgG, C1q and C3 are seen in the glomerular basement membrane he glomerular basement membrane and mesangium. Electron microscopand mesangium. Electron microscopy confirms the presence of electron dy confirms the presence of electron dense deposits in the basement membense deposits in the basement membrane, predominantly in a subepithelirane, predominantly in a subepithelial location.al location.
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Diseases of urinary Diseases of urinary systemsystem
GlomerulonephritisGlomerulonephritis Tubulointerstitial nephritisTubulointerstitial nephritis Diseases of the lower urinary Diseases of the lower urinary
tracttract Tumors of urinary systemTumors of urinary system
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Tubulointerstitial nepTubulointerstitial nephritishritis
Tubulointerstitial nephritis Tubulointerstitial nephritis refers to a group of inflamrefers to a group of inflammatory diseases of the kidnmatory diseases of the kidneys that primarily involve teys that primarily involve the he interstituminterstitum and and tubulestubules
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Tubulointerstitial nepTubulointerstitial nephritishritis
Pyelonephritis Pyelonephritis Acute tubular necrosisAcute tubular necrosis Interstitial nephritisInterstitial nephritis
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PyelonephritisPyelonephritis Affecting tubulesAffecting tubules Affecting interstitumAffecting interstitum Affecting renal pelvisAffecting renal pelvis One of the most common diseOne of the most common dise
ases of the kidneyases of the kidney
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PyelonephritisPyelonephritis
Acute pyelonephritisAcute pyelonephritis Chronic pyelonephritisChronic pyelonephritis
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Acute pyelonephritisAcute pyelonephritis Incidence parallels that of obIncidence parallels that of ob
structive uropathystructive uropathy Caused by bacterial infectionCaused by bacterial infection Common suppurative inflamCommon suppurative inflam
mation of the kidney and the rmation of the kidney and the renal pelvisenal pelvis
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Acute pyelonephritisAcute pyelonephritis
Childhood Childhood Pregnancy Pregnancy Elderly Elderly
Infancy: Infancy: malesmales>females>females
Puberty to Puberty to middle age: middle age: females>malesfemales>males
Post-40 years: Post-40 years: malesmales>females>females
Three age Three age peakspeaks
Gender Gender differencesdifferences
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Routes of bacterial Routes of bacterial infectioninfection
Ascending infection from thAscending infection from the lower urinary tract(most ce lower urinary tract(most common): ommon): enteric gram-negaenteric gram-negative rods ( Escherichia coli)tive rods ( Escherichia coli)
Bloodstream spread in bactBloodstream spread in bacteremic or septicemic states: eremic or septicemic states: staphylococcistaphylococci
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Route of infection
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Gross featureGross feature
Suppurative inflammationSuppurative inflammation Cortical abscessesCortical abscesses Medullary abscessesMedullary abscesses
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Acute pyelonephriAcute pyelonephritistis
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Acute pyelonephritisAcute pyelonephritis
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Histological featureHistological feature
Infiltration of tubules by neutrInfiltration of tubules by neutrophilsophils
Abscess formationAbscess formation Interestitial edemaInterestitial edema
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Acute pyelonephritis
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Clinical featureClinical feature Sudden onsetSudden onset Pain in the backPain in the back Evidence of systemic infection( Evidence of systemic infection(
chills, fever, malaise)chills, fever, malaise) Indications of bladder and uretIndications of bladder and uret
hral irritation( dysuria, urgenchral irritation( dysuria, urgency, frequency of micturition)y, frequency of micturition)
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Urinary findingsUrinary findings
Pyuria ( white blood cells Pyuria ( white blood cells and pus cells in urine)and pus cells in urine)
Bacteriuria (bacteria in uBacteriuria (bacteria in urine)rine)
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Complications and sequComplications and sequelaeelae
ResolutionResolution Healing with scarringHealing with scarring ChronicityChronicity PyonephrosisPyonephrosis Renal papillary necrosisRenal papillary necrosis Perinephric abscessPerinephric abscess Death in uremiaDeath in uremia
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Papillary necrosis
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PyelonephritisPyelonephritis
Acute pyelonephritisAcute pyelonephritisChronic pyelonephritisChronic pyelonephritis
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Chronic pyelonephritiChronic pyelonephritiss
Chronic pyelonephritis is defineChronic pyelonephritis is defined as a morphologic entity in whicd as a morphologic entity in which prodominantly interstitial inflah prodominantly interstitial inflammation and mmation and scarringscarring of the renof the renal parenchyma is associated with al parenchyma is associated with grossly grossly visible scarringvisible scarring and and defordeformitymity of the pelvicalyceal systemof the pelvicalyceal system
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Chronic pyelonephritiChronic pyelonephritiss
Obstructive chronic pyeloneObstructive chronic pyelonephritisphritis
Reflux-associated Reflux-associated chronic pchronic pyelonephritis (vesicoureterayelonephritis (vesicoureteral reflux)l reflux)
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Gross featureGross feature
Kidneys are not equally damaKidneys are not equally damagedged
Irregular areas of scarringIrregular areas of scarring Marked calyceal deformitiesMarked calyceal deformities
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Gross feature
• not equally damaged• Irregular areas of scarring• Marked calyceal deformities
Chronic pyelonephritis
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Chronic pyelonephritis
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Histological featureHistological feature Chronic inflammatory cells infChronic inflammatory cells inf
iltration, occasionally neutropiltration, occasionally neutrophilshils
Uneven interstitial fibrosisUneven interstitial fibrosis Dilation or contraction of tubuDilation or contraction of tubu
lesles Glomeruli show periglomerulaGlomeruli show periglomerula
r fibrosisr fibrosis
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Chronic pyelonephritis
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“Thyroidization” Dilation of tubules
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Clinical featureClinical feature
Gradual onset of renal insufGradual onset of renal insufficiencyficiency
Tubular dysfunction (polyuTubular dysfunction (polyuria)ria)
Urinary tract infectionUrinary tract infection Uremia Uremia
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DiagnosisDiagnosis
Intravenous pyelogramIntravenous pyelogram Urine cultureUrine culture
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RequirementRequirement
List the complications of acute pList the complications of acute pyelonephritisyelonephritis
Name the two types of pathogenName the two types of pathogenesis for chronic pyelonephritisesis for chronic pyelonephritis
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OutlineOutline GlomerulonephritisGlomerulonephritis Tubulointerstitial nephritisTubulointerstitial nephritis Diseases of the lower urinary Diseases of the lower urinary
tracttract Tumors of urinary systemTumors of urinary system
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Infection Infection ObstructionObstruction Stone Stone
formationformation Tumor Tumor
formationformation Developmental Developmental
abnormalitiesabnormalities
Diseases of the lower urinary tract
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Urinary outflow Urinary outflow obstructionobstruction
Renal stonesRenal stones HydronephrosisHydronephrosis
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Renal stonesRenal stones
Urolithiasis is calculus forUrolithiasis is calculus formation at any level in the urmation at any level in the urinary collecting systeminary collecting system
most common sites: pelvicmost common sites: pelvicalyceal system and bladder.alyceal system and bladder.
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Main predisposing Main predisposing factorsfactors
Increased concentration Increased concentration of solute in urine of solute in urine
Reduced solubility of Reduced solubility of solute in urine solute in urine
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EtiologyEtiology
Acquired Acquired InheritedInherited
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Renal calculus
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Renal staghorn calculus
S
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Staghorn calculus
Hydronephrosis
Abscess
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Fluoroscopy
Ureteral calculus
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Clinical featureClinical feature
Without symptomsWithout symptoms Renal colic with nausea , vomRenal colic with nausea , vom
iting and hematuriaiting and hematuria Dual ache in the loinsDual ache in the loins Recurrent urinary tract infectRecurrent urinary tract infect
ionion
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Urinary outflow Urinary outflow obstructionobstruction
Renal stonesRenal stones HydronephrosisHydronephrosis
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Hydronephrosis Hydronephrosis
Hydronephrosis refers to Hydronephrosis refers to didilation of the renal pelvis anlation of the renal pelvis and calycesd calyces, with accompanyi, with accompanying ng atrophy of the parenchyatrophy of the parenchymama, caused by obstruction t, caused by obstruction to the outflow of urine o the outflow of urine
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Renal pelvisRenal pelvis Pelviureteric juncPelviureteric junc
tiontion UreterUreter BladderBladder UrethraUrethra
HydronephrosisHydronephrosisObstruction of the levelsObstruction of the levels
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MorphologyMorphology Unilateral :caused by obstructiUnilateral :caused by obstructi
on at the level of the ureter, pelon at the level of the ureter, pelviureteric junction or renal pelviureteric junction or renal pelvis vis
Bilateral: caused by obstruction Bilateral: caused by obstruction of the level of the bladder or urof the level of the bladder or urethra ethra
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Hydronephrosis
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Normal urinary tract
Intravenous pyelogram (IVP)
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Hydronephrosis Intravenous pyelogram (IVP)
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Hydronephrosis ( cut surface)
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Clinical featureClinical feature
Clinical features depend Clinical features depend on the cause and site of on the cause and site of the lesionthe lesion
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Effects of hydronephrEffects of hydronephrosisosis
Obstruction is removed: renaObstruction is removed: renal function returns to normall function returns to normal
Persistence of obstruction: atPersistence of obstruction: atrophy of renal tubules with grophy of renal tubules with glomerular hyalinization and flomerular hyalinization and fibrosisibrosis
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OutlineOutline GlomerulonephritisGlomerulonephritis Tubulointerstitial nephritiTubulointerstitial nephriti
ss Diseases of the lower urinaDiseases of the lower urina
ry tract ry tract Tumors of urinary systemTumors of urinary system
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Tumors of urinary Tumors of urinary systemsystem
Tumors of the kidneyTumors of the kidney Tumors of the bladderTumors of the bladder Tumors of the ureterTumors of the ureter Tumors of the urethraTumors of the urethra
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Angiomyolipoma
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AngiomyolipomaMRI
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Angiomyolipoma
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Renal cell carcinoma
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Renal cell carcinoma invade into the renal vein
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MRIRenal cell carcinoma
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Renal cell carcinoma (clear cell type)
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Key factsKey factsrenal cell carcinomarenal cell carcinoma
Male: female incidence is 3:1Male: female incidence is 3:1 Incidence is greatest in those over 5Incidence is greatest in those over 5
0 years, and increases with age0 years, and increases with age Common presenting symptoms inclCommon presenting symptoms incl
ude ude painless hematuriapainless hematuria, loin pain, l, loin pain, loin massoin mass
Occasional presenting symptoms inOccasional presenting symptoms include bone metastasis,brain metastclude bone metastasis,brain metastasis, polycythemia asis, polycythemia
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Key factsKey factsrenal cell carcinomarenal cell carcinoma
Local spread through renal capsulLocal spread through renal capsule into perinephritic fate into perinephritic fat
Lymphatic spread to para-aortic aLymphatic spread to para-aortic and other nodesnd other nodes
Blood stream spread to lungs, bonBlood stream spread to lungs, bone, brain, livere, brain, liver
Prognosis depends on stage at presPrognosis depends on stage at presentationentation
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Wilm’s tumor (Nephroblastoma)
Common malignant
tumors of childhood
Abdominal enlargement
Genetic defects on chromosome 11
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Wilm’s tumor
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Metastatic carcinoma of the kidney
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QuestionsQuestions
List five kinds of diseases List five kinds of diseases of unilateral enlargement of unilateral enlargement of the kidney.of the kidney.
What are the causes of What are the causes of urinary tract obstruction?urinary tract obstruction?
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Tumors of the lower Tumors of the lower urinary tracturinary tract
Most tumors of the lower Most tumors of the lower urinary tract arise from urinary tract arise from transitional-cell transitional-cell epitheliumepithelium
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Transitional cell carcinoma of the bladder
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Intravenous pyelogram (IVP)
Carcinoma of the bladder
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Carcinoma of renal pelvis
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Transitional cell carcinoma
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Case studyCase study
A 57-year-old draughtsman who presenA 57-year-old draughtsman who presents to his family practitioner complainints to his family practitioner complaining of a dragging sensation in his left loin.g of a dragging sensation in his left loin. On questioning, he admits to having h On questioning, he admits to having had intermittent painless hematuria for ad intermittent painless hematuria for three weeks. Following referral to a urthree weeks. Following referral to a urological surgeon, investigation reveals ological surgeon, investigation reveals a large mass replacing the left kidney. a large mass replacing the left kidney. He undergoes a left nephrectomy from He undergoes a left nephrectomy from which he makes a good recovery. which he makes a good recovery.
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QuestionsQuestions
What is the most likely What is the most likely diagnosis?diagnosis?
The most likely diagnosis is renal cell carcinoma
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QuestionsQuestions
What is the most common histological What is the most common histological pattern of this lesion and what causes this pattern of this lesion and what causes this appearance?appearance?
Carcinomas of the kidney are adenocarcinomas. The most common histological pattern is of lipid and glycogen within the cytoplasm of neoplastic cells
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QuestionsQuestions What factors in the histopathologists report What factors in the histopathologists report
would have a particular bearing on the progwould have a particular bearing on the prognosis for this patient?nosis for this patient?
If carcinoma is present within blood vessels (particularly the renal veins) at the hilum, then there is a greater likelihood that metastasis spread will ensue. If tumor is confined within the renal capsule there is a 70% 10-year survival