Amyloidosis. Amyloidosis of the kidney Disease LMEMIF Membranous GNThickened GBMSubepithelial...
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Amyloidosis
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Amyloidosis of the kidney
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Disease LM EM IF
Membranous GN Thickened GBM Subepithelial Deposits
Granular fl.of GBM
MPGN
Minimal change
Focal and
Seg.GS
Focal GN
Lupus Nephritis
Amyloidosis
DM
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Chronic GNDef: it is end stage renal glomerular disease.
Grossly:-Small contracted kidney.-Granular outer surface.-Firmly adherent capsule.-Loss of differentiation bet. cortex and medulla.-Thick BVs at corticomedullary junction.
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Chronic GN: Note contracted kidney& granular outer surface
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Msc:
Glomeruli: -Hyalinised and sclerotic.-Some are hypertrophied.
Tubules are atrophied and
dilated
Interstitial fibrosis and
chronic inflammatory cell
infiltration
Thick walle-blood vessels end arteritis obliterans
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Chronic glomerulonephritis
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Hyaline cast
Chronic GN
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Clinical and laboratory Findings:
Marked hypertension
IncreaseBl. urea
Urine changes-Polyuria.- low Specific gra.-Mild albuminuria.-Hyaline and -granular casts
Prognosis: without Treatment is poor
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Small- Sized Kidney (contracted kidney)
1-Hypoplastic kidney.
2-Chronic GN
3-Chronic PN
4-Senile(atherosclerotic) kidney.
5-Kidney of benign hypertension (Benign nephrosclerosis).
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DMEffects of DM on the kidney:-Diabetic GS-Renal arteriolar sclerosis.-pyelonephritis.-papillary necrosis.
Diabetic GSIt leads to:a-Proteinuria.B-Nephrotic syndrome.C-CRF.
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MSC: 1-Diffuse GS.-Diffuse increase in mesangial matrix-Thickening of GBM2-Nodular GS. (kimmelsteil Wilson disease)Hyaline nodule is present in the mesangium,Containing fibrin and lipid.
3-Insudative lesion:-fibrin cap; eosinophilic focal Thickening of peripheral capillary loop.-Capsular drop: eosinophilic thickening of Bowman’s capsule
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Diffuse glomeruosclerosis
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Nodular GS
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Nodular GS
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Fibrin cap and Capsular drop
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Lupus nephritis
Presentation: Recurrent hematuria,nephritic s,nephrotic s,hypertension,CRF.
Classification;-class I:Normal kidney.-Class II:Mesangial glomerular lesion.-Class III:Focal proliferaive GN.-Class IV:Diffuse Proliferative GN.-Class V:Membranous GN.-Class VI:Advancing sclerosing GN.
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MSC of Class IV: Diffuse Proliferative GN
-Diffuse hypercellularity due to Proliferation of endothelial cells and mesangial cells -Irregular thickening of GBM - Wire loop appearance-Few epith.crescents-Hematoxylin bodies.
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Proliferative lupus nephritisFlea-Bitten appearance
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Class II: Mesangial GN
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Class III: Focal GN
Focal and segmental necrosis of glomerulus
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Class IV:Diffuse Proliferaive GN
Hematoxylin bodies Wire-Loop appearance
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IF of Lupus Nephritis
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EM of Lupus Nephritis
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• IF: Granular fluorescence of capillary walls for Igs and comploments
• EM: Subendothelial and mesangial electron dense deposits
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Tubulointerstitial nephritisDef: diseases affecting tubules and interstitial tissues of the kidney.
1-Pyelonephritis
Pelvis of the kidney is commonly involved in bacterial infection,hence pyeloCause: bacterial infection as E-coli ,B. proteus, B. pyocyaneus and others
PF: -obstruction. -Vesicoureteric reflux-Instrumentation. -Female sex.-Pregnancy. -DM.-Bilhaziasis.
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Routes of infection
-Ascending Lymphatic from GIT
HematogenousFrom boil
Acute PN
Grossly:-Enlarged kidney. -Congested PCS-Yellow streaks from papillae to cortex.
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Acute PN
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Yellow foci of pus
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Acute pyelonephritis
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Chronic PNCharacterized by:-Interstitial inflammation and scarring-Deformity andscarring of pelvicalyceal system
Gross-Small sized kidney (contracted).-Irregular outer surface due to retraction of the capsule.-Distorted pelvicalceal system .
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Chronic pyelonephritis
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Chronic PN
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Microscopic:
-Periglomerular fibrosis -Dilated tubules containing hyaline casts (thyrodization)-Thick walled BVs-Interstitial fibrosis and chronic inflammatory cell infiltration.
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Microscopic of Ch.PN
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Chronic PN. Note periglomerular fibrosis
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Ch. PN. Thyrodization
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Complication
-Secondary hypertension.-proteinuria.-Chronic renal failure.
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Other types of renal infection
-Pyaemia-Tuberculosis.
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2-Drug-induced interstitial nephritisMechanisms:1-immunologic reaction or hypersensitivity reaction type I Acute interstitial nephritis e.g rifampicin, penicellin,thiazides
2-Slow damage to tubules Chronic interstitial nephritis via type IV reaction e.g. Analgesic nephropathy
3-Direct nephrotoxicity ATN
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Drug induced interstitial nephritis
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Chronic tubulointerstitial nephritis
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3-Acute tubular necrosis
Def: destruction of tubular epithelial cells with acute suppression of kidney function. It is reversible renal lesion.
Types
Anoxic(ischemic) ATN:-Mismatched biood trasfusion-Shock &severe hypotension-Severe trauma
Toxic ATN-poisons as Mgcl,CCl4,Phosphorus,&insecticides-Drugs e.g. gentam,amphotricin B
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Acute tubular necrosis
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Acute tubular necrosis
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Vascular diseases of the kidney
1-Renal artery stenosisCause:-Atheromatous plaque. -Fibromuscular dysplasia.Effects: secondary hypertension(2-5%),due to renin production.
2-InfarctsPresented by painless hematuria.Causes:-Embolism -Thrombosis on top AS
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Atheromatous plaque
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Thrombosed renal artery
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Infarct of the Kidney
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Infact kidney
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Infarction of The kidney
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3-Senile atherosclerotic kidneyGrossly:-Both kidneys are reduced in size.-The outer surfaces show depressions due to scarring-The renal artery is atheromatous.
MSC:-Wedge-shaped areas of fibrosis.-Hyalinized glomeruli.- Tubules.are replaced by fibrous tissue
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Atherosc.of the aorta and kidneys
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Aortic Aneurysm with thrombus and senile kidneys
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Atherosclerotic kidney
Atherosclerotic renal artery
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Atheromatous plaque
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4-Hypertension
A-Benign nephrosclerosis
Grossly;-Both kidneys are reduced in size (contracted)-Granular outer surface-Loss of demarcation between cortex and medulla
Microscopic;-Hyaline arteriolosclerosis-Fibroelastic hyperplasia of large arteries-Diffuse ischemic atrophy of the nephron
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B. Nephrosclerosis
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Arteiolosclerotic kidney
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Arteriolonephrosclerosis
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Benign nephrosclerosis
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Benign Nephrosclerosis
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B-Malignant nephrosclerosis
Grossly:-Enlarged kidney with peticheal he
Microscopic:-Fibrinoid necrosis-Smooth muscle proliferation and duplication of basementmembrane ( onion-skin appearance)-Necrotizing glomerulitis
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Fibrinoid necrosis in malignant hypertension
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Malig. Nephrosclerosis. Onion –skin appearance
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5-Bilateral cortical necrosisRare lesionCause; ischemic as in toxemia of pregnancy or severe infections such as pneumonias and diphtheriasGross; yellow cortex of both kidneysMSC: Coagulative necrosis
6-Necrosis of renal papillaeRare lesionCause :ischemic necrosis due to PN, with DM, excess phenacetin and chronic alcoholism
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Cortical necrosis
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Necrosis of renal papillae
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Necrotizing papillitis
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Necrosis of renal papillae