1. General Pathology
    2. 1. The Cell as a Unit of Health and Disease
    2. Cellular Response to Stress and Toxic Insults
    3. Inflammation and Repair
    4. Hemodynamic Disorders, Thromboembolic Disease, and Shock
    5. Genetic Disorders
    6. Diseases of the Immune System
    7. Neoplasia
    8. Infectious Diseases
    9. Environmental and Nutritional Diseases
    10. Diseases of Infancy and Childhood
  2. Systemic Pathology: Diseases of Organ Systems
    3. 11. Blood vessels
    12. The Heart
    13. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus
    14. Red Blood Cell and Bleeding Disorders
    15. The Lung
    16. Head and Neck
    17. The Gastrointestinal Tract
    18. Liver and Gallbladder
    19. The Pancreas
    20. The Kidney
    21. The Lower Urinary Tract and Male Genital System
    22. The Female Genital Tract
    23. The Breast
    24. The Endocrine System
    25. The Skin
    26. Bones, Joints, and Soft Tissue Tumors
    27. Peripheral Nerves and Skeletal Muscles
    28. The Central Nervous System
    29. The Eye
Systemic Pathology: Diseases of Organ Systems
20. The Kidney
CLINICAL MANIFESTATIONS OF RENAL DISEASES
GLOMERULAR DISEASES
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Structure of the Glomerulus
Pathologic Responses of the Glomerulus to Injury
Pathogenesis of Glomerular Injury
Diseases Caused by In Situ Formation of Immune Complexes
Disease Caused by Antibodies Directed Against Normal Components of the Glomerular Basement Membrane
Glomerulonephritis Resulting from Deposition of Circulating Immune Complexes
Mediation of Glomerular Injury Following Immune Complex Formation
Cell-Mediated Immunity in Glomerulonephritis
Activation of Alternative Complement Pathway
Mediators of Glomerular Injury
Epithelial Cell Injury
Mechanisms of Progression in Glomerular Diseases
Classification of Glomerular Disease
Primary glomerulonephritis
Etiology
Gross
Light microscopic
Electron microscopic
Immunofluoroscence microscopic
Clinical features
Acute Proliferative Glomerulonephritis (APGN)/ Post-streptococcal glomerulonephritis (PSGN)
Ag-Ab planted
Plea-beaten kidney
  1. ↑ Glomerular size
  2. Hypercellular
  3. Hyperproliferative neutrophil
Subepithelial
IgG+C3+GABHS
Nephritic syndrome
Rapidly progressive glomerulonephritis (RPGN)/ Crescentric glomerulonephritis
▢ Type I:
▢ Type II:
▢ Type III:
Enlarged kidney
  1. ↑ Glomerular size
  2. Hypercellular
  3. Hyperproliferative neutrophil
  4. Crescent formation
▢ Type I: Intramembranous
▢ Type II: Subepithelial
▢ Type III: x (no deposit)
IgG + C3
Nephritic syndrome
Minimal Change Disease (MCD)
Increased size
Normal
No deposit, Fusion or flatenning of Podocytes
IgG + C3
Nephrotic syndrome
Membranous glomerulonephritis (MGN)
Increased size

Glomerular basement membrane thickening

  1. Looks double
Subepithelial (Spike)
IgG + C3
Nephrotic syndrome
Membranoproliferative glomerulonephritis (MPGN)
Increased size

Glomerular basement membrane thickening

  1. Hypercellular
  2. Tram-track appearace
▢ Type I: Subendothelial
▢ Type II: Intramembranous
▢ Type III: Anywhere
IgG + C3
Nephrotic syndrome
Focal Segmental Glomerulonephritis (FSGN)
Increased size
Hypercellular
X
IgG + C3
Nephrotic syndrome
Focal Segmental Glomerulosclerosis (FSGS)
Increased size
Scelerosis -> Solidification
X
IgG + C3
Nephrotic syndrome
Chronic glomerulonephritis (CGN)
  1. Small
  2. Contracted
  1. GBM->Hyalinized
  2. Tubules -> Small
  3. Blood vessels -> Thickening (Arteroclerosis)
  4. Interstitium -> Chronic inflammation
X
IgG + C3
Nephrotic syndrome
IgA nephropathy/ Berger's Disease
Increased size
Mesangial deposits
Mesangium
IgA
Nephrotic syndrome
Secondary glomerulonephritis
Nephritic Syndrome
Differences between Nephritic and Nephrotic Syndrome
Character
Nephritic syndrome
Nephrotic syndrome
Blood in urine
Protein in urine
Haematuria
Visible or Microscopic haematuria
-
Proteinuria
  • •
    Mild proteinuria
  • •
    Non-selective proteinuria
  • •
    High proteinuria (>3gm/24hr)
  • •
    Selectively albuminuria
Protein in blood
-
  1. Hypoalbuminaemia
  2. ↓ Immunoglobin
    • •
      Verneable to infection
    • •
      Spontaneous bacterial proteinitis
      • •
        Pneumococci
      • •
        E. coli
  3. ↓ Antithrombin -> Renal vein thrombosis
  4. ↓ Transferrin -> Fe deficiency -> Anaemia
  5. ↓ Cholecalciferol binding protein -> Hypocalcaemia
  6. ↓ Thyroxine binding globulin
  7. ↓ Ceruloplasmin
  8. ↑ Fibrinogen
Oedema
Oedema due to increased Na+/H2O retention
Oedema due to decreased Osmotic pressure
Blood pressure
Hypertension
Hyperlipidaemia
-
Hyperlipidaemia
Lipiduria
-
Lipiduria
Coagulability
-
Hypercoagulability
Urine output
Oliguria (<400ml/24hr)
-
Most common
RPGN (Rapidly progressive glomerulonephritis
  1. Children -> Minimal Change Disease (MCD)
  2. Adult -> Membranous Glomerulonephritis (MGN)
Acute Proliferative (Poststreptococcal, Postinfectious) Glomerulonephritis
Rapidly Progressive (Crescentic) Glomerulonephritis
Nephrotic Syndrome
Membranous Nephropathy
Minimal-Change Disease
Focal Segmental Glomerulosclerosis (FSGS)
Membranoproliferative Glomerulonephritis (MPGN)
Dense Deposit Disease
Isolated Glomerular Abnormalities
IgA Nephropathy (Berger Disease)
Hereditary Nephritis
Chronic Glomerulonephritis
Glomerular Lesions Associated with Systemic Diseases
Lupus Nephritis
Henoch-Schönlein Purpura
Glomerulonephritis Associated with Bacterial Endocarditis and Other Systemic Infections
Diabetic Nephropathy
Fibrillary Glomerulonephritis
Other Systemic Disorders
TUBULAR AND INTERSTITIAL DISEASES
Acute Tubular Injury/Necrosis
Tubulointerstitial Nephritis
Pyelonephritis and Urinary Tract Infection
Acute Pyelonephritis
Chronic Pyelonephritis and Reflux Nephropathy
Tubulointerstitial Nephritis Induced by Drugs and Toxins
Acute Drug-Induced Interstitial Nephritis
Other Tubulointerstitial Diseases
Urate Nephropathy
Hypercalcemia and Nephrocalcinosis
Acute Phosphate Nephropathy
Light-Chain Cast Nephropathy ("Myeloma Kidney")
Bile Cast Nephropathy
VASCULAR DISEASES
Nephrosclerosis
Malignant Nephrosclerosis
Renal Artery Stenosis
Thrombotic Microangiopathies
Other Vascular Disorders
Atherosclerotic Ischemic Renal Disease
Atheroembolic Renal Disease
Sickle-Cell Nephropathy
Diffuse Cortical Necrosis
Renal Infarcts
CONGENITAL AND DEVELOPMENTAL ANOMALIES
CYSTIC DISEASES OF THE KIDNEY
Autosomal Dominant (Adult) Polycystic Kidney Disease
Autosomal Recessive (Childhood) Polycystic Kidney Disease
Cystic Diseases of Renal Medulla
Medullary Sponge Kidney
Nephronophthisis and Adult-Onset Medullary Cystic Disease
Multicystic Renal Dysplasia
Acquired (Dialysis-Associated) Cystic Disease
Simple Cysts
URINARY TRACT OBSTRUCTION (OBSTRUCTIVE UROPATHY)
UROLITHIASIS (RENAL CALCULI, STONES)
NEOPLASMS OF THE KIDNEY
Benign Neoplasms
Renal Papillary Adenoma
Angiomyolipoma
Oncocytoma
Malignant Neoplasms
Renal Cell Carcinoma
Urothelial Carcinoma of the Renal Pelvis