"View a negative experience in your life like you'd look at a photo negative. A single negative can create an unlimit...
Pathology of Kidney Disorders Dr. Venkatesh M. Shashidhar Associate Professor of Pathology Fiji School of Medicine
Anatomy-Kidney
Components of Glomerulus: <ul><li>Capillary basement membrane </li></ul><ul><li>Mesangium </li></ul><ul><li>Bowman capsule...
Anatomy of Kidney
Anatomic Compartments <ul><li>Glomerulus </li></ul><ul><li>Tubules </li></ul><ul><li>Blood vessels </li></ul><ul><li>Inter...
Kidney Functions: <ul><li>Excretion metabolic waste/drugs. </li></ul><ul><li>Water/fluid balance. </li></ul><ul><li>Electr...
<ul><li>Note the positions of  </li></ul><ul><li>Glomerulus </li></ul><ul><li>Loop of Henley </li></ul><ul><li>PCT, DCT, C...
JGA GFR    Renin  Angiotensin Blood Pressure
Filtration Membrane:
Normal Kidney:
Kidney Diseases <ul><li>Developmental disorders </li></ul><ul><li>Glomerular diseases </li></ul><ul><li>Tubulo-interstitia...
Congenital Anomalies: Agenesis – Potter syndrome Ectopia  Fusion Dysplasia Simple cysts Polycystic kidney disease
Horse Shoe Kidney
Double Ureter:
Polycystic kidney disease <ul><li>Autosomal dominant (adult) (1:1,000) </li></ul><ul><li>Autosomal recessive (infantile (1...
Autosomal Dominant PKD <ul><li>Common kidney disease (1:1,000) </li></ul><ul><li>10% of all transplant/dialysis patients <...
ADPKD:
ADPKD:
ADPKD  Associated Conditions <ul><li>Liver cysts (30%) </li></ul><ul><li>Splenic cysts (10%) </li></ul><ul><li>Pancreatic ...
Kidney Disorders – clinical. A Asymptomatic hematuria/proteinuria N Nephrotic syndrome N Nephritic syndrome U Urolithiasis...
“ To be a great champion you must believe you are the best. If you’re not, pretend you are.”     – Muhammad Ali
Glomerular Disorders:
<ul><li>Nephritic </li></ul><ul><li>Hematuria </li></ul><ul><li>Proteinuria </li></ul><ul><li>Hypoalbuminemia </li></ul><u...
Acute Post Strepto. GN: Synonyms : Incidence : Etiology : Clinical : Lab: Path: Clinical Course: Acute proliferative glome...
Minimal Change GN: Synonyms : Incidence : Etiology : Clinical Features: Lab Features: Pathology : Clinical Course: Nil dis...
Membranous GN: Synonyms: Incidence : Etiology: Clinical: Lab: Path: Clinical Course: Epimembranous, extramembranous GN Imm...
Membranoproliferative GN Etiology : Chronic immune complex GN. Associated with chronic infections, SLE, cancer, cirrhosis,...
Causes of nephrotic syndrome Disease Children (%) Adults (%) Minimal change GN  75   20 Membanous  GN    5   40 MPGN I   5...
Chronic renal failure  (uremia) <ul><li>General symptoms – weakness, fatigue </li></ul><ul><li>Cardiovascular – hypertensi...
Chronic Renal Failure: ESKD
CRF- ESKD with transplant:
Diabetic kidney diseases <ul><li>Glomerulosclerosis </li></ul><ul><li>Arteriolosclerosis    Hypertension </li></ul><ul><l...
Diabetic glomerulosclerosis <ul><li>Diabetes BM thickening Proteinuria   renal failure (leading cause of mortality in DM)...
Diabetic Glomerulosclerosis Hyaline nodules
Diabetic Glomerulosclerosis KW lesion…
Benign  Nephrosclerosis: Leathery Granularity  due to minute scarring
Renal Artery stenosis - Atrophy Leathery Granularity Benign Nephrosclerosis
IgA Nephropathy (berger) <ul><li>Most common form of GN </li></ul><ul><li>Young adults (15-30 years) </li></ul><ul><li>IgA...
Nephrosclerosis - Hypertension <ul><li>Benign  </li></ul><ul><li>sustained mild hypertension. </li></ul><ul><li>hyaline ar...
Thrombotic microangiopathy <ul><li>Morphologic finding in several diseases </li></ul><ul><li>microangiopathic hemolytic an...
Renal infarcts <ul><li>Thromboemboli </li></ul><ul><li>Mural thrombi </li></ul><ul><li>(M.I., atrial fibrillation) </li></...
Renal Infarcts:
Renal Infarct:
Renal Infarct:
Acute Tubular Necrosis: <ul><li>Common cause of acute renal failure </li></ul><ul><li>“ Dirty” brown casts in urine </li><...
Acute Pyelonephritis <ul><li>Bacterial infection (E. coli 80%) </li></ul><ul><li>Ascending / hematogenous </li></ul><ul><l...
Septicemia-Microabscess
Septicemia-Microabscess
Acute Pyelonephritis with papillary necrosis (diabetes)
Septicemia-abscess
Pyelonephritis –  Predisposing Cond.  U   Urolithiasis R  Reflux (vesico-ureteric) I  Infections of lower UT N   Neoplasms...
Chronic Pyelonephritis Pathology <ul><li>Destruction of renal tissue and fibrosis </li></ul><ul><ul><li>Cortical scars </l...
Drug induced renal disorders: <ul><li>Acute tubular necrosis(toxic) Gentamycin, mercury, contrast agents. </li></ul><ul><l...
Urolithiasis – Stones:
Urolithiasis: <ul><li>1-5%, environment, males, pelvis </li></ul><ul><li>Renal colic, dull ache in loins </li></ul><ul><li...
Urolithiasis – stones: Infection 6%  Other  1%  Cystine  6%  Uric acid  12%  Magnesium ammonium phosphate (struvite, or &q...
Hypercalcemia / Hypercalciuria <ul><li>Primary  (increased intestinal absorption of Ca) </li></ul><ul><ul><li>Idiopathic (...
Urolithiasis:
Staghorn Calculus:
Urolithiasis with hydronephrosis:
Hydronephrosis:
Hydronephrosis:
Urolithiasis – sites of impaction
Hydronephrosis - Urolithiasis
Causes of Obstructive Uropathy
Urolithiasis: Incidence : Etiology : Clinical Features : Lab : Path : Clinical Course : Environmental, metabolic, infectio...
“ The weak can never forgive. Forgiveness is the attribute of the strong.”    –Mohandas Gandhi
Renal tumors <ul><li>Benign  </li></ul><ul><ul><li>Adenoma, oncocytoma, angiomyolipoma, fibroma (rare!) </li></ul></ul><ul...
Angiomyolipoma (Benign)
Renal Papillary Adenoma <ul><li>Papillary </li></ul><ul><li>Common </li></ul><ul><li>Histopathology similar to renal Cell ...
Oncocytoma  (DCT epithelia, benign)
Wilm’s Tumor Incidence : Etiology : Clinical Features: Lab : Path: Clinical Course: Embryonic renal tissue (metanephric bl...
Renal Cell Carcinoma <ul><li>Most common renal tumor </li></ul><ul><li>Peak age – 60y  M:F = 3:1 </li></ul><ul><li>Inciden...
RCC - Pathology <ul><li>Yellow orange tumor –Hypernephroma.  </li></ul><ul><li>Partially encapsulated </li></ul><ul><li>Ex...
Renal Cell Carcinoma:
Renal Cell Carcinoma:
Renal Cell Carcinoma:
Renal Cell Carcinoma:
RCC – Clinical Features: <ul><li>Classical triad (hematuria, flank pain, mass) (<10%) </li></ul><ul><li>Hematuria (50%) mo...
Renal Cell Carcinoma: Incidence : Etiology : Clinical Features : Lab : Path : Clinical Course: Cells of proximal convolute...
Wilms tumor <ul><li>Childhood tumor (2-5y) 98%< 10 years </li></ul><ul><li>Most common tumor in childhood </li></ul><ul><l...
Wilms Tumor:
Transitional Cell Carcinoma: <ul><li>5-10% of adult renal ca. </li></ul><ul><li>Etiology: Analgesic abuse, dye, rubber etc...
Transitional cell Carcinoma:
Transitional cell Carcinoma:
Transitional cell Carcinoma:
Wilms Tumor Features: <ul><li>Lobulated tumors mass –encapsulated </li></ul><ul><li>Histology: mixture of immature cells m...
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Pathology Of Kidney

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Pathology Of Kidney

  1. 1. &quot;View a negative experience in your life like you'd look at a photo negative. A single negative can create an unlimited number of positive prints.&quot; Gerhard Gschwandtner Founder of &quot;Selling Power&quot; magazine
  2. 2. Pathology of Kidney Disorders Dr. Venkatesh M. Shashidhar Associate Professor of Pathology Fiji School of Medicine
  3. 3. Anatomy-Kidney
  4. 4. Components of Glomerulus: <ul><li>Capillary basement membrane </li></ul><ul><li>Mesangium </li></ul><ul><li>Bowman capsule </li></ul><ul><li>Cells </li></ul><ul><ul><li>Endothelial </li></ul></ul><ul><ul><li>Epithelial </li></ul></ul><ul><ul><li>Mesangial </li></ul></ul>
  5. 5. Anatomy of Kidney
  6. 6. Anatomic Compartments <ul><li>Glomerulus </li></ul><ul><li>Tubules </li></ul><ul><li>Blood vessels </li></ul><ul><li>Interstitium </li></ul><ul><li>Collecting system </li></ul><ul><li>(Callices & Pelvis) </li></ul>
  7. 7. Kidney Functions: <ul><li>Excretion metabolic waste/drugs. </li></ul><ul><li>Water/fluid balance. </li></ul><ul><li>Electrolyte balance. </li></ul><ul><li>Acid-base balance. </li></ul><ul><li>Blood pressure. </li></ul><ul><li>Erythropoietin secretion. </li></ul>
  8. 8. <ul><li>Note the positions of </li></ul><ul><li>Glomerulus </li></ul><ul><li>Loop of Henley </li></ul><ul><li>PCT, DCT, CT </li></ul><ul><li>Cortex, Medulla, Pelvis. </li></ul>Anatomy of Kidney
  9. 9. JGA GFR  Renin  Angiotensin Blood Pressure
  10. 10. Filtration Membrane:
  11. 11. Normal Kidney:
  12. 12. Kidney Diseases <ul><li>Developmental disorders </li></ul><ul><li>Glomerular diseases </li></ul><ul><li>Tubulo-interstitial diseases </li></ul><ul><li>Urinary stones </li></ul><ul><li>Obstructive uropathy </li></ul><ul><li>Tumors </li></ul>
  13. 13. Congenital Anomalies: Agenesis – Potter syndrome Ectopia Fusion Dysplasia Simple cysts Polycystic kidney disease
  14. 14. Horse Shoe Kidney
  15. 15. Double Ureter:
  16. 16. Polycystic kidney disease <ul><li>Autosomal dominant (adult) (1:1,000) </li></ul><ul><li>Autosomal recessive (infantile (1:30,000) </li></ul><ul><li>Medullary cystic disease complex (1:10,000) </li></ul><ul><li>Medullary sponge kidney </li></ul><ul><li>Acquired cystic renal disease </li></ul>
  17. 17. Autosomal Dominant PKD <ul><li>Common kidney disease (1:1,000) </li></ul><ul><li>10% of all transplant/dialysis patients </li></ul><ul><li>ADPKD-1 gene (polycystin) mutation 85% </li></ul><ul><li>Bilaterally enlarged kidneys (>3,000g) </li></ul><ul><li>Symptoms appear in adult life </li></ul><ul><li>Renal failure 5-10 years thereafter </li></ul>
  18. 18. ADPKD:
  19. 19. ADPKD:
  20. 20. ADPKD Associated Conditions <ul><li>Liver cysts (30%) </li></ul><ul><li>Splenic cysts (10%) </li></ul><ul><li>Pancreatic cysts (5%) </li></ul><ul><li>Cerebral aneurysms (20%) </li></ul><ul><li>Diverticulosis coli </li></ul>
  21. 21. Kidney Disorders – clinical. A Asymptomatic hematuria/proteinuria N Nephrotic syndrome N Nephritic syndrome U Urolithiasis R Rapidly progressive glomerulonephritis I Interstitial and tubular diseases C Chronic renal disease
  22. 22. “ To be a great champion you must believe you are the best. If you’re not, pretend you are.” – Muhammad Ali
  23. 23. Glomerular Disorders:
  24. 24. <ul><li>Nephritic </li></ul><ul><li>Hematuria </li></ul><ul><li>Proteinuria </li></ul><ul><li>Hypoalbuminemia </li></ul><ul><li>Oliguria (GFR  , Cr  , BUN  ) </li></ul><ul><li>Edema (salt and water retention) </li></ul><ul><li>Hypertension </li></ul><ul><li>Nephrotic </li></ul><ul><li>Proteinuria (“nephrotic range” >3.5g/24h) </li></ul><ul><li>Hypoalbumimenia </li></ul><ul><li>Edema </li></ul><ul><li>Hyperlipidemia </li></ul><ul><li>Lipiduria </li></ul>
  25. 25. Acute Post Strepto. GN: Synonyms : Incidence : Etiology : Clinical : Lab: Path: Clinical Course: Acute proliferative glomerulonephritis, acute post-infectious GN. Glomerular trapping of circulating anti-streptococcal immune complexes. Group A, B-hemolytic streptococci, type 12. Acute nephritic syndrome post-strept pharyngitis or pyoderma. Other infections. Nephritic urine with RBC casts. Evidence of streptococcal infection or serologic evidence of recent infection. Decreased serum complement. Children - Excellent prognosis. Adults - Worse prognosis, some develop progressive disease. Enlarged, hypercellular glomeruli with endothelial and mesangial cell proliferation. Acute inflammation. IgG and C3 in very coarsely granular pattern along GBMs. Discrete, subepithelial “hump-like” deposits. Peak incidence in children (3-14). Sporatic, mostly winter and spring.
  26. 26. Minimal Change GN: Synonyms : Incidence : Etiology : Clinical Features: Lab Features: Pathology : Clinical Course: Nil disease, lipoid nephrosis, foot process disease Idiopathic. Loss of net negative charge on capillary basement membrane. Nephrotic syndrome. History of recent URI in 30%. Association with Hodgkin’s lymphoma. Overlap with FSGS patients. Selective proteinuria. No specific laboratory findings. Spontaneous remission in 25-40%. Complete remission in 65-70% of patients. Steroid resistant patients may progress to FSGS. LM - Normal. IF - Negative. EM - Focal fusion/loss of foot processes. 80% of nephrotic syndrome in children (1-8 yrs.), mostly male. Adults in 2nd-3rd decade.
  27. 27. Membranous GN: Synonyms: Incidence : Etiology: Clinical: Lab: Path: Clinical Course: Epimembranous, extramembranous GN Immune complex disease. Idiopathic in most patients, associated with infections, drugs, carcinomas, and heavy metals. Nephrotic syndrome in 80%, asymptomatic proteinuria in 20%. Microscopic hematuria. Non-selective proteinuria ± hematuria. Excellent prognosis in children. Some adults develop ESRD. Exclusion of other diseases is required. Diffuse, uniform BM thickening with subepithelial projections (“spikes”). Diffuse, coarsely granular IgG and C3 deposits along basement membranes. Electron-dense subepithelial deposits. 40-60 Years, 50% of adult nephrotic syndrome.
  28. 28. Membranoproliferative GN Etiology : Chronic immune complex GN. Associated with chronic infections, SLE, cancer, cirrhosis, heroin abuse, etc. Clinical : Nephrotic syndrome in 50%, acute nephritic syndrome in 20%. Recent history of URI in 50%. Hypertension and/or renal insufficiency. Lab : Hypocomplementemia of classic and alternate pathways. C3 nephritic factor (C3NEF). Circulating immune complexes. Clinical Course: Progressive deterioration of renal function ± short remissions. ESRD within 10 years in 50% of children and 80% of adults. Path: Diffuse proliferative GN with thickening of the glomerular capillary walls,, and GBM splitting (“tram-tracking”). Diffuse, coarsely granular C3 and IgG deposits along GBMs. Electron-dense subendothelial deposits. Incidence : Children and young adults (5-25 years).
  29. 29. Causes of nephrotic syndrome Disease Children (%) Adults (%) Minimal change GN 75 20 Membanous GN 5 40 MPGN I 5 5 Other GN 5 20
  30. 30. Chronic renal failure (uremia) <ul><li>General symptoms – weakness, fatigue </li></ul><ul><li>Cardiovascular – hypertension, pericarditis </li></ul><ul><li>G.I. – nausea, vomiting, diarrhea </li></ul><ul><li>CNS – lethargy, confusion, coma </li></ul><ul><li>Muscles – twitching, weakness </li></ul><ul><li>Bones – osteodystrophy </li></ul><ul><li>Metabolic – acidosis, P  K  , BUN  , Cr  . </li></ul><ul><li>Endocrine - parathyroids  </li></ul>
  31. 31. Chronic Renal Failure: ESKD
  32. 32. CRF- ESKD with transplant:
  33. 33. Diabetic kidney diseases <ul><li>Glomerulosclerosis </li></ul><ul><li>Arteriolosclerosis  Hypertension </li></ul><ul><li>Pyelonephritis </li></ul><ul><li>Papillary necrosis </li></ul>
  34. 34. Diabetic glomerulosclerosis <ul><li>Diabetes BM thickening Proteinuria  renal failure (leading cause of mortality in DM) </li></ul><ul><li>nonenzymatic glycation (?), BM synthesis  , leaky. </li></ul><ul><li>Pathology: </li></ul><ul><ul><li>Diffuse global thickening of BM </li></ul></ul><ul><ul><li>Nodular sclerosis (K-W) </li></ul></ul><ul><ul><li>Arteriolosclerosis </li></ul></ul><ul><ul><li>Trapping of serum proteins </li></ul></ul><ul><li>Clin: Proteinuria (in 50% diabetics) </li></ul><ul><li>ESKD (30%) </li></ul>
  35. 35. Diabetic Glomerulosclerosis Hyaline nodules
  36. 36. Diabetic Glomerulosclerosis KW lesion…
  37. 37. Benign Nephrosclerosis: Leathery Granularity due to minute scarring
  38. 38. Renal Artery stenosis - Atrophy Leathery Granularity Benign Nephrosclerosis
  39. 39. IgA Nephropathy (berger) <ul><li>Most common form of GN </li></ul><ul><li>Young adults (15-30 years) </li></ul><ul><li>IgA deposits in mesangium, varied severity </li></ul><ul><li>Asymptomatic microscopic hematuria (40%) </li></ul><ul><li>Bouts of macro hematuria (40%) </li></ul><ul><li>Nephrotic syndrome (10%) </li></ul><ul><li>Renal failure (10%) </li></ul>
  40. 40. Nephrosclerosis - Hypertension <ul><li>Benign </li></ul><ul><li>sustained mild hypertension. </li></ul><ul><li>hyaline arteriolosclerosis </li></ul><ul><li>arterial fibrosis </li></ul><ul><li>glomerular hyalinization, tubular atrophy </li></ul><ul><li>Malignant </li></ul><ul><li>BP>125 mm/Hg, retinal hemorrhage, papilledema, renal dysfunction </li></ul><ul><li>fibrinoid necrosis of arterioles </li></ul><ul><li>microthrombi </li></ul>
  41. 41. Thrombotic microangiopathy <ul><li>Morphologic finding in several diseases </li></ul><ul><li>microangiopathic hemolytic anemia </li></ul><ul><li>HUS, TTP, Malignant nephrosclerosis </li></ul><ul><li>Systemic sclerosis </li></ul>
  42. 42. Renal infarcts <ul><li>Thromboemboli </li></ul><ul><li>Mural thrombi </li></ul><ul><li>(M.I., atrial fibrillation) </li></ul><ul><li>Endocarditis </li></ul><ul><li>Aortic thrombi (atherosclerosis) </li></ul><ul><li>Cholesterol emboli </li></ul>
  43. 43. Renal Infarcts:
  44. 44. Renal Infarct:
  45. 45. Renal Infarct:
  46. 46. Acute Tubular Necrosis: <ul><li>Common cause of acute renal failure </li></ul><ul><li>“ Dirty” brown casts in urine </li></ul><ul><li>Oliguria  anuria  polyuria </li></ul><ul><ul><li>Azotemia </li></ul></ul><ul><ul><li>Acidosis, K  </li></ul></ul><ul><ul><li>Fluid retention </li></ul></ul><ul><li>Recovery 1-2 weeks </li></ul>
  47. 47. Acute Pyelonephritis <ul><li>Bacterial infection (E. coli 80%) </li></ul><ul><li>Ascending / hematogenous </li></ul><ul><li>Lower UTI precedes renal infection </li></ul><ul><li>Fever, flank pain, neutrophilia </li></ul><ul><li>Leukocyte casts in urine </li></ul><ul><li>Healing - recurrence  chronic pyelonephritis </li></ul>
  48. 48. Septicemia-Microabscess
  49. 49. Septicemia-Microabscess
  50. 50. Acute Pyelonephritis with papillary necrosis (diabetes)
  51. 51. Septicemia-abscess
  52. 52. Pyelonephritis – Predisposing Cond. U Urolithiasis R Reflux (vesico-ureteric) I Infections of lower UT N Neoplasms (ureteric, vesical, prostatic) E External compression (e.g.) pregnancy retroperitoneal fibrosis
  53. 53. Chronic Pyelonephritis Pathology <ul><li>Destruction of renal tissue and fibrosis </li></ul><ul><ul><li>Cortical scars </li></ul></ul><ul><ul><li>Loss of papillae </li></ul></ul><ul><ul><li>Ectasia of calices </li></ul></ul><ul><ul><li>Hydronephrosis </li></ul></ul><ul><li>Irregularly shrunken small kidney </li></ul><ul><li>Chronic inflammatory infiltrates </li></ul><ul><li>Tubular atrophy with casts (“thyroidization”) </li></ul>
  54. 54. Drug induced renal disorders: <ul><li>Acute tubular necrosis(toxic) Gentamycin, mercury, contrast agents. </li></ul><ul><li>Acute tubulointerstitial nephritis (allergic) – methicillin, thiazides. </li></ul><ul><li>Analgesic nepropathy (Phenacetin) chronic tubulointerstitial nephritis with papillary necrosis. </li></ul>
  55. 55. Urolithiasis – Stones:
  56. 56. Urolithiasis: <ul><li>1-5%, environment, males, pelvis </li></ul><ul><li>Renal colic, dull ache in loins </li></ul><ul><li>Urinary tract infection recurrent. </li></ul><ul><li>Factors affecting: </li></ul><ul><li>Urine pH, Infection, Metabolic, </li></ul><ul><li>Pyrophosphates and citrate inhibit. </li></ul>
  57. 57. Urolithiasis – stones: Infection 6% Other 1% Cystine 6% Uric acid 12% Magnesium ammonium phosphate (struvite, or &quot;triple phosphate&quot;) 75% Calcium oxalate (or phosphate)
  58. 58. Hypercalcemia / Hypercalciuria <ul><li>Primary (increased intestinal absorption of Ca) </li></ul><ul><ul><li>Idiopathic (most common) </li></ul></ul><ul><ul><li>Milk-alkali syndrome </li></ul></ul><ul><ul><li>Vitamin D excess </li></ul></ul><ul><ul><li>Sarcoidosis </li></ul></ul><ul><li>Secondary (release of Ca from bones) </li></ul><ul><ul><li>Renal osteodystrophy </li></ul></ul><ul><ul><li>Hyperparathyroidism </li></ul></ul><ul><ul><li>Osteolytic metastases (e.g. breast cancer) </li></ul></ul><ul><ul><li>Paraneoplastic syndromes (PTrP) </li></ul></ul>
  59. 59. Urolithiasis:
  60. 60. Staghorn Calculus:
  61. 61. Urolithiasis with hydronephrosis:
  62. 62. Hydronephrosis:
  63. 63. Hydronephrosis:
  64. 64. Urolithiasis – sites of impaction
  65. 65. Hydronephrosis - Urolithiasis
  66. 66. Causes of Obstructive Uropathy
  67. 67. Urolithiasis: Incidence : Etiology : Clinical Features : Lab : Path : Clinical Course : Environmental, metabolic, infectious. Develop silently until episode of renal colic. Cause obstruction, pain, infection, hydronephrosis, and hydroureter. Gross or mcroscopic hematuria. Chemical analysis to identify type of stone. Characteristic radiographic findings. May recur. Complications are the problem. Calcium phosphate or oxalate - Hard, sharp. Uric acid - Smooth. Staghorn - Cast of calyceal system. Common, male predominance. Treatment : Surgery, lithotomy, or ultrasonic lithotripsy to remove stone. Treatment of metabolic process, if indicated. Adequate hydration.
  68. 68. “ The weak can never forgive. Forgiveness is the attribute of the strong.” –Mohandas Gandhi
  69. 69. Renal tumors <ul><li>Benign </li></ul><ul><ul><li>Adenoma, oncocytoma, angiomyolipoma, fibroma (rare!) </li></ul></ul><ul><li>Malignant: </li></ul><ul><ul><li>Renal cell carcinoma (common – adults) </li></ul></ul><ul><ul><li>Wilms tumor (childhood) </li></ul></ul><ul><ul><li>Transitional cell carcinoma of renal pelvis </li></ul></ul>
  70. 70. Angiomyolipoma (Benign)
  71. 71. Renal Papillary Adenoma <ul><li>Papillary </li></ul><ul><li>Common </li></ul><ul><li>Histopathology similar to renal Cell Carcinoma. </li></ul><ul><li>< 3cm – benign </li></ul><ul><li>> 3cm - malignant </li></ul><ul><li>All tumors considered malignant until proved otherwise. </li></ul>
  72. 72. Oncocytoma (DCT epithelia, benign)
  73. 73. Wilm’s Tumor Incidence : Etiology : Clinical Features: Lab : Path: Clinical Course: Embryonic renal tissue (metanephric blastema). Genetic abnormalities. Palpable abdominal mass. Abdominal pain, fever, anorexia, nausea/vomiting. Hematuria. No specific clinical laboratory findings. Diagnosis by radiographic techniques. 5-yr. Survival 80%. Metastases to lung, liver, bone, brain. Gross: Solitary/multiple cystic mass, sharply delineated. Soft, bulging, gray-white with focal hemorrhage and necrosis. Micro: Triphasic mesenchymal stroma, tubules, and solid areas (blastema). Primitive glomeruli, skeletal muscle, cartilage, bone, etc. (embryonic tissues) Most common renal tumor of childhood. Peak age - 2.5 - 3.5 years. Treatment: Prompt resection with chemotherapy ± radiotherapy. Synonyms : Nephroblastoma.
  74. 74. Renal Cell Carcinoma <ul><li>Most common renal tumor </li></ul><ul><li>Peak age – 60y M:F = 3:1 </li></ul><ul><li>Incidence increasing world wide </li></ul><ul><li>Tobacco; Obesity, genetics (VHLgene, familial cases) </li></ul><ul><li>Von Hippel-Lindau syndrome </li></ul><ul><ul><li>Hemangioblastoma cerebellum retina </li></ul></ul><ul><ul><li>Bilateral renal cysts, </li></ul></ul><ul><ul><li>Clear cell type RCC – common. </li></ul></ul>
  75. 75. RCC - Pathology <ul><li>Yellow orange tumor –Hypernephroma. </li></ul><ul><li>Partially encapsulated </li></ul><ul><li>Extends into renal vein </li></ul><ul><ul><li>tubular clear cell (77%) </li></ul></ul><ul><ul><li>papillary (15%) </li></ul></ul><ul><ul><li>granular, chromophobe, sarcomatoid (5%) </li></ul></ul>
  76. 76. Renal Cell Carcinoma:
  77. 77. Renal Cell Carcinoma:
  78. 78. Renal Cell Carcinoma:
  79. 79. Renal Cell Carcinoma:
  80. 80. RCC – Clinical Features: <ul><li>Classical triad (hematuria, flank pain, mass) (<10%) </li></ul><ul><li>Hematuria (50%) most common symptom </li></ul><ul><li>Metastases-hematogenous and local abdominal </li></ul><ul><li>Paraneoplastic syndromes (PTH, Epo, amyloid) </li></ul><ul><li>5 year survival = 40% </li></ul>
  81. 81. Renal Cell Carcinoma: Incidence : Etiology : Clinical Features : Lab : Path : Clinical Course: Cells of proximal convoluted tubule. Risk factors are smoking, obesity, analgesic abuse, APCKD. Hematuria*, flank pain, palpable mass. Frequently metastasize (lungs, bone, skin, liver, brain). Gross or microscopic hematuria. Specific Dx by radiographic techniques. 5-yr. survival 40%. Poor prognosis with metastases. Gross: Large yellow mass with hemorrhage and necrosis. Invade renal vein. Micro: Usually clear or granular cells with little anaplasia. Other histologic variants (“great mimicker”). 5 th and 6 th decades, most common primary renal malignancy. Treatment : Chemotherapy, surgery, immunotherapy. Synonyms : Hypernephroma, clear cell carcinoma.
  82. 82. Wilms tumor <ul><li>Childhood tumor (2-5y) 98%< 10 years </li></ul><ul><li>Most common tumor in childhood </li></ul><ul><li>Sporadic, unilateral (90%) </li></ul><ul><li>Bilateral more common in familial cases (20%) </li></ul><ul><li>Familial syndromic (5%), nonsyndromic (5%) </li></ul><ul><li>WAGR sy – Aniridia, genital abn, Mental Ret. WT1 </li></ul><ul><li>Beckwith Wiedemann sy - Hemihypertrophy – WT2 </li></ul>
  83. 83. Wilms Tumor:
  84. 84. Transitional Cell Carcinoma: <ul><li>5-10% of adult renal ca. </li></ul><ul><li>Etiology: Analgesic abuse, dye, rubber etc.. </li></ul><ul><li>Multiple common. </li></ul><ul><li>Malignant cells in urine </li></ul><ul><li>Desquamated tissue may cause obstruction. </li></ul><ul><li>Hematuria & pain. </li></ul>
  85. 85. Transitional cell Carcinoma:
  86. 86. Transitional cell Carcinoma:
  87. 87. Transitional cell Carcinoma:
  88. 88. Wilms Tumor Features: <ul><li>Lobulated tumors mass –encapsulated </li></ul><ul><li>Histology: mixture of immature cells metanephric, stromal, tubular </li></ul><ul><li>Chemotherapy + surgery = 5 years = 90% </li></ul><ul><li>Children < 2 years better prognosis </li></ul>
  89. 89. “ When you develop the habits of success, success will become a habit.” http://SuccessNet.org
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