PATHOLOGY OF KIDNEYS
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PATHOLOGY OF KIDNEYS
VII. practical training 3rd year General Medicine
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Normal glomerulus
1 Capillary lumen2 Basement membrane3 Podocytyes 4 Mesangial cells5 Proximal tubulus6 Bowman’s capsule7 Mesangial matrix8 Distal tubulus9 Macula densa
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Capillary loops – electronogram
1
PodocytesPodocytal processus
Basement membrane
Endothelium
Mesangial cell
Mesangial matrix
Capillary lumen
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Cystic kidney diseases
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Cystic kidney diseases
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Infantile cystosis (Microcystosis) of kidneys
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Microcystosis
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Vascular nephrosclerosis
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Vascular nephrosclerosis
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Vascular nephrosclerosis
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Vascular nephrosclerosis
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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
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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
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Nomenclature of glomerular injury
• Diffuse - all glomeruli
• Focal - some glomeruli, others unaffected
• Global - the whole glomerulus
• Segmental - only part of the glomerulus
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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
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Diabetic glomerulosclerosis (Kimmelstiel-Wilson)
1 hyaline deposits in mesangial matrix of glomerulus
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Diabetic glomerulosclerosis (Kimmelstiel-Wilson)
1 hyaline globules in mesangial matrix of glomerulus2 capillaries around hyaline globules3 hyalinosis of mesangium
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Armani’s cells (PAS)
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Endocapillary proliferative glomerulonefritis
1 Reduction of capillary lumen2 Bulge and proliferation of cellular formation of glomerulus
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Endocapillary proliferative glomerulonefritis
immunoflourescenc-subendothelial immune-complex deposit
1
1 Granular subendothelialdeposits on basal membrane
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E Swelling endothelial cells 1 Basal membrane Stars- subendothelial deposits of immunoglobulins on basal membrane
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Endocapillary proliferative glomerulonefritis, electronogram
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Diffuse sclerozing glomerulonefritis
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Diffuse sclerozing glomerulonefritis
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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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Rapidly progressive (crescentic) glomerulonephritis
1 Basal membrane of Bowman capsule2 Fibrin3 Hyaline deposits in glomerular capillaries
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Acute suppurative pyelonephritis
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Acute suppurative pyelonephritis
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Acute suppurative pyelonephritis
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Chronic pyelonephritis
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Chronic pyelonefritis (end stage kidney, anamnesis of prostatic hypertrophy)
Dilatated ureter
Capsule of kidney
End stage kidney
Kidney without big changes
Chronic urocystitis
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Amyloid nephropathy
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Amyloid nephropathy
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Biliary nephrosis
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Hydronephrosis
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Hydronephrosis
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Wilms’ tumour (nephroblastoma)
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Wilms’ tumour (nephroblastoma)
11 Stromal component 2 Blastema component3 Epithelial component
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Nephroblastoma
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Renal cell carcinoma, conventional type
tumour
Lower pole of kidney
Kidney in section
Tumour invasion inside vein in hilus
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Renal cell carcinoma, clear cell type
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Renal cell carcinoma, clear cell type