KIDNEY
www.freelivedoctor.com
RENAL PATHOLOGY
• NORMAL
• CONGENITAL
• “CYSTS”
• GLOMERULAR
• TUBULAR/INTERSTITIAL
• BLOOD VESSELS
• OBSTRUCTION
• TUMORS...
www.freelivedoctor.com
www.freelivedoctor.com
1. Renal Vein
2. Renal Artery
3. Renal Calyx
4. Medullary Pyramid
5. Renal Cortex
6. Segmental Artery
7. InterlobAR Artery...
www.freelivedoctor.com
S.E.M. T.E.M.www.freelivedoctor.com
www.freelivedoctor.com
Fluid and Electrolytes: Dehydration, Edema, Hyperkalemia, Metabolic acidosis
Calcium Phosphate and Bone: Hyperphosphatemia...
CONGENITAL
• AGENESIS
• HYPOPLASIA
• ECTOPIC
• HORSESHOE
www.freelivedoctor.com
AGENESIS
www.freelivedoctor.com
HYPOPLASIA
www.freelivedoctor.com
ECTOPIC (usually PELVIC)
www.freelivedoctor.com
HORSESHOE
www.freelivedoctor.com
CYSTIC DISEASES
• CYSTIC RENAL “DYSPLASIA”
• Autosomal DOMINANT (AD-ULTS)
• Autosomal RECESSIVE (CHILDREN)
• MEDULLARY
– M...
CYSTIC RENAL “DYSPLASIA”
• ENLARGED
• UNILATERAL or BILATERAL
• CYSTIC
• Have “MESENCHYME”
• NEWBORNS
www.freelivedoctor.c...
AUTOSOMAL DOMINANT
• HEREDITARY, PKD1, PKD2
• FOLLOWS AUTOSOMAL DOMINANT
PEDIGREE
• COMPLEX GENETICS
• RENAL FAILURE in 50...
AUTOSOMAL RECESSIVE
• CHILDHOOD
• KIDNEYS LOOK EXACTLY LIKE THE
ADULT TYPE
• PKHD1
• PATIENTS WHO SURVIVE CHILDHOOD
OFTEN ...
MEDULLARY CYSTS
• MEDULLARY SPONGE KIDNEY (MSK), usually an
incidental finding on CT or US
. NEPHRONOPHTHISIS, cysts @ CMJ...
ACQUIRED (DIALYSIS)
www.freelivedoctor.com
“SIMPLE” CYSTS
• Cortical
• Also called “retention” cysts
• Also “acquired”
• Incidental
• VERY very very common
www.freel...
GLOMERULAR DISEASES
www.freelivedoctor.com
CLINICAL MANIFESTATIONS
• ACUTE NEPHROTIC SYNDROME
• RAPIDLY PROGRESSIVE
GLOMERULONEPHRITIS
• NEPHROTIC SYNDROME
• CHRONIC...
PATHOLOGIC MANIFESTATIONS
• CELLULAR PROLIFERATION
– Mesangial
– Endothelial
• LEUKOCYTE INFILTRATION
• CRESCENTS (RAPIDLY...
PATHOGENESIS
• Antibodies against inherent GBM
• Antibodies against “planted” antigens
• Trapping of Ag-Ab complexes
• Ant...
www.freelivedoctor.com
MEDIATORS
• NEUTROPHILS, MONOCYTES
• MACROPHAGES, T-CELLS, NK CELLS
• PLATELETS
• MESANGIAL CELLS
• SOLUBLE: CYTOKINES, CH...
ACUTE GLOMERULONEPHRITIS
• Hematuria, Azotemia, Oliguria, in children
following a strep infection
• POSTSTREPTOCOCCAL (old...
www.freelivedoctor.com
RAPIDLY PROGRESSIVE
GLOMERULONEPHRITIS
• Clinical definition,
NOT a specific
pathologic one
• “CRESCENTIC”
• Anti-GBM Ab
•...
NEPHROTIC SYNDROME
• MASSIVE PROTEINURIA
• HYPOALBUMINEMIA
• EDEMA
• LIPIDEMIA/LIPIDURIA
• NUMEROUS CAUSES:
– MEMBRANOUS, ...
MEMBRANOUS
GLOMERULONEPHRITIS
• Drugs, Tumors, SLE, Infections
• Deposition of Ag-Ab complexes
• Indolent, but >60% persis...
www.freelivedoctor.com
MINIMAL CHANGE GLOM.
(LIPOID NEPHROSIS)
• MOST COMMON CAUSE of NEPHROTIC SYNDROME
in CHILDREN
• EFFACEMENT of FOOT PROCESS...
FOCAL SEGMENTAL
GLOMERULO-SCLEROSIS
• Just like its name
– Focal
– Segmental
– Glomerulo-SCLEROSIS (NOT –itis)
• HIV, Hero...
MEMBRANOPROLIFERATIVE
GLOMERULONEPHRITIS
• MPGN can be idiopathic or 2º
to chronic immune diseases
Hep-C, alpha-1-antitryp...
IgA NEPHROPATHY
(BERGER DISEASE)
• Mild hematuria
• Mild proteinuria
• IgA deposits in mesangium
www.freelivedoctor.com
HEREDITARY HEMATURIA
SYNDROMES
• ALPORT SYNDROME
– Progressive Renal Failure
– Nerve Deafness
– VARIOUS eye disorder
– DEF...
CHRONIC
GLOMERULONEPHRITIS
• Can result from just about ANY of
the previously described acute
ones
– THIN CORTEX
– HYALINI...
SECONDARY (2º)
GLUMERULONEPHROPATHIES
• SLE
• Henoch-Schonlein Purpura (IgA-NEPH)
• BACTERIAL ENDOCARDITIS
• DIABETES (Nod...
www.freelivedoctor.com
TUBULES
INTERSTITIUM
BLOOD VESSELS
OBSTRUCTION
TUMORS
www.freelivedoctor.com
TUBULAR DISEASES
• ACUTE TUBULAR NECROSIS
• TUBULOINTERSTITIAL NEPHRITIS
– PYELONEPHRITIS
• ACUTE
• CHRONIC
– DRUGS
– TOXI...
ACUTE TUBULAR NECROSIS
• Destruction of renal TUBULAR epithelium
• Loss of renal function
• 50% of ACUTE renal failure
• T...
ATN PATHOGENESIS
• BLOOD FLOW DISTURBANCES
(ISCHEMIC)
• TUBULAR INJURY
(NEPHROTOXIC)
www.freelivedoctor.com
CLINICAL COURSE
• INITIATION (36 hours)
– Mild OLIGURIA
– Mild AZOTEMIA
• MAINTENANCE
– More OLIGURIA
– More AZOTEMIA
– DI...
TUBULO/INTERSTITIAL NEPHRITIS
• INFECTIONS, i.e., pyelonephritis
• TOXINS, heavy metals, chemo, NSAIDS
• METABOLIC, urates...
PYELONEPHRITIS
• GI Gram NEGATIVES: E. COLI, Proteus,
Klebsiella, Enterobacter, Strep. faecalis, usually
“NORMAL” flora
• ...
ACUTE or CHRONIC PYELONEPHRITIS?
www.freelivedoctor.com
ACUTE or CHRONIC PYELONEPHRITIS?
www.freelivedoctor.com
ACUTE or CHRONIC PYELONEPHRITIS?
www.freelivedoctor.com
FACTORS
• OBSTRUCTION: Congenital or Acquired
• INSTRUMENTATION
• VESICOURETERAL REFLUX
• PREGNANCY
• AGE, SEX, why sex? F...
DRUGS/TOXINS causing
INTERSTITIAL NEPHRITIS
• Synthetic Penicillins
• Rifampin
• Thiazides
• 2 weeks later: Fever, eosinop...
ANALGESIC NEPHROPATHY
• ASPIRIN, TYLENOL, NSAIDS
– TUBULOINTERSTITIAL NEPHRITIS
– PAPILLARY NECROSIS (also Dm & HbS)
www.f...
URATE NEPHROPATHY
• Precipitation of Uric Acid Crystals in the TUBULES,
especially in a LOWER than usual PH situation (min...
HYPERCALCEMIA
NEPHROCALCINOSIS
PRINCIPLE:In extreme or uncontrolled or
chronic HYPERCALCEMIA, calcium stones form in
the t...
MULTIPLE MYELOMA
• Bence Jones proteinuria
(immunoglobulin light chains)
• AMYLOIDOSIS
www.freelivedoctor.com
VASCULAR DISEASES
• BENIGN NEPHROSCLEROSIS
• MALIGNANT NEPHROSCLEROSIS (i.e., malignant
hypertension)
• RENAL ARTERY STENO...
BENIGN NEPHROSCLEROSIS
• Sclerosis, i.e., “hyalinization” of arterioles and small
arteries, i.e., arterio-, arteriolo-
• I...
MALIGNANT NEPHROSCLEROSIS (i.e.,
malignant hypertension)
• NOT a part of “routine” atherosclerosis
• By definition, associ...
Renal Artery Stenosis
• Rare cause of HTN
• SMALL Kidney
• 1) Plaque type is usual cause, yes regular
old atherosclerosis
...
PLAQUE, i.e.,
ATHEROSCLEROSIS
FIBROMUSCULAR
DYSPLASIA
www.freelivedoctor.com
MICROANGIOPATHIES
(thrombotic)
• Hemolytic-Uremic Syndrome
– Familial
– Childhood
– Adult
• TTP (Thrombotic Thrombocytopen...
MICROANGIOPATHIES
COMMON
PROCESSES
–Hemolysis
–Thromboses in renal
capillaries
–Thrombocytopenia (a
“consumption”
coagulop...
OTHER VASCULAR
• Atherosclerosis
• Atheroemboli
• Sickle Cell
• Diffuse Cortical
Necrosis
www.freelivedoctor.com
RENAL INFARCTS
• WEDGE SHAPED
• WELL DELINEATED
• “WHITE” (anemic) INFARCT
• Perhaps a little “YELLOW”
• HEAL WITH A SCAR
...
www.freelivedoctor.com
OBSTRUCTIONS
• UROLITHIASIS
• CONGENITAL
• PROSTATE ENLARGEMENT
• TUMORS
• INFLAMMATION
• SLOUGHED CLOTS, PAPILLAE
• PREGN...
UROLITHIASIS
• CALCIUM (OXALATE or
PHOSPHATE) 70%
• MAGNESIUM AMMONIUM
PHOSPHATE 20%
• URIC ACID 10%
CA↑↑↑
Bact.
U.A. ↑↑↑
...
TUMORS
• BENIGN
– Papillary Adenoma
– Fibroma/Hamartoma
– Angiomyolipoma
– Oncocytoma
• MALIGNANT
– Renal Cell Carcinoma (...
RENAL CELL CARCINOMA
• TOBACCO RELATED, STRONGLY
• SOME HEREDITARY/FAMILIAL
• MOST are “CLEAR CELL”, a few
PAPILLARY
• YEL...
UROTHELIAL (TRANSITIONAL)
RENAL CARCINOMAS
• In renal pelvis. Why?
• 1/10 as common as renal cell carcinomas
• EXACTLY the...
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  • Pitting geographic “scars” is the hallmark of chronic pyelonephritis.
  • THYROIDIZATION is another common hallmark of chronic pyelonephritis
  • Renalpathology atglance-100417030042-phpapp02

    1. 1. KIDNEY www.freelivedoctor.com
    2. 2. RENAL PATHOLOGY • NORMAL • CONGENITAL • “CYSTS” • GLOMERULAR • TUBULAR/INTERSTITIAL • BLOOD VESSELS • OBSTRUCTION • TUMORS www.freelivedoctor.com
    3. 3. www.freelivedoctor.com
    4. 4. www.freelivedoctor.com
    5. 5. 1. Renal Vein 2. Renal Artery 3. Renal Calyx 4. Medullary Pyramid 5. Renal Cortex 6. Segmental Artery 7. InterlobAR Artery 8. Arcuate Artery interlobULAR 9. Arcuate Vein 10. Interlobar Vein 11. Segmental Vein 12. Renal Column 13. Renal Papillae 14. Renal Pelvis 15. Ureter www.freelivedoctor.com
    6. 6. www.freelivedoctor.com
    7. 7. S.E.M. T.E.M.www.freelivedoctor.com
    8. 8. www.freelivedoctor.com
    9. 9. Fluid and Electrolytes: Dehydration, Edema, Hyperkalemia, Metabolic acidosis Calcium Phosphate and Bone: Hyperphosphatemia, Hypocalcemia, Secondary hyperparathyroidism, Renal osteodystrophy Hematologic: Anemia, Bleeding diathesis Cardiopulmonary: Hypertension, Congestive heart failure, Pulmonary edema, Uremic pericarditis Gastrointestinal: Nausea and vomiting, Bleeding, Esophagitis, gastritis, colitis Neuromuscular: Myopathy, Peripheral neuropathy, Encephalopathy Dermatologic: Sallow (greenish-yellow) color, Pruritus, Dermatitis CHRONIC RENAL FAILURE www.freelivedoctor.com
    10. 10. CONGENITAL • AGENESIS • HYPOPLASIA • ECTOPIC • HORSESHOE www.freelivedoctor.com
    11. 11. AGENESIS www.freelivedoctor.com
    12. 12. HYPOPLASIA www.freelivedoctor.com
    13. 13. ECTOPIC (usually PELVIC) www.freelivedoctor.com
    14. 14. HORSESHOE www.freelivedoctor.com
    15. 15. CYSTIC DISEASES • CYSTIC RENAL “DYSPLASIA” • Autosomal DOMINANT (AD-ULTS) • Autosomal RECESSIVE (CHILDREN) • MEDULLARY – Medullary Sponge Kidney (MSK) – Nephronopththisis-Medullary • ACQUIRED • SIMPLE www.freelivedoctor.com
    16. 16. CYSTIC RENAL “DYSPLASIA” • ENLARGED • UNILATERAL or BILATERAL • CYSTIC • Have “MESENCHYME” • NEWBORNS www.freelivedoctor.com
    17. 17. AUTOSOMAL DOMINANT • HEREDITARY, PKD1, PKD2 • FOLLOWS AUTOSOMAL DOMINANT PEDIGREE • COMPLEX GENETICS • RENAL FAILURE in 50’s www.freelivedoctor.com
    18. 18. AUTOSOMAL RECESSIVE • CHILDHOOD • KIDNEYS LOOK EXACTLY LIKE THE ADULT TYPE • PKHD1 • PATIENTS WHO SURVIVE CHILDHOOD OFTEN DEVELOP HEPATIC FIBROSIS www.freelivedoctor.com
    19. 19. MEDULLARY CYSTS • MEDULLARY SPONGE KIDNEY (MSK), usually an incidental finding on CT or US . NEPHRONOPHTHISIS, cysts @ CMJ, hereditary, progressive www.freelivedoctor.com
    20. 20. ACQUIRED (DIALYSIS) www.freelivedoctor.com
    21. 21. “SIMPLE” CYSTS • Cortical • Also called “retention” cysts • Also “acquired” • Incidental • VERY very very common www.freelivedoctor.com
    22. 22. GLOMERULAR DISEASES www.freelivedoctor.com
    23. 23. CLINICAL MANIFESTATIONS • ACUTE NEPHROTIC SYNDROME • RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS • NEPHROTIC SYNDROME • CHRONIC RENAL FAILURE • ASYMPTOMATIC HEMATURIA or PROTEINURIA www.freelivedoctor.com
    24. 24. PATHOLOGIC MANIFESTATIONS • CELLULAR PROLIFERATION – Mesangial – Endothelial • LEUKOCYTE INFILTRATION • CRESCENTS (RAPIDLY progressive) • BASEMENT MEMBRANE THICKENING • HYALINIZATION • SCLEROSIS www.freelivedoctor.com
    25. 25. PATHOGENESIS • Antibodies against inherent GBM • Antibodies against “planted” antigens • Trapping of Ag-Ab complexes • Antibodies against glomerular cells, e.g., mesangial cells, podocytes, etc. • Cell mediated immunity, i.e., sensitized T-cells as in TB www.freelivedoctor.com
    26. 26. www.freelivedoctor.com
    27. 27. MEDIATORS • NEUTROPHILS, MONOCYTES • MACROPHAGES, T-CELLS, NK CELLS • PLATELETS • MESANGIAL CELLS • SOLUBLE: CYTOKINES, CHEMOKINES, COAGULATION FACTORS www.freelivedoctor.com
    28. 28. ACUTE GLOMERULONEPHRITIS • Hematuria, Azotemia, Oliguria, in children following a strep infection • POSTSTREPTOCOCCAL (old term) • HYPERCELLULAR GLOMERULI • INCREASED ENDOTHELIUM AND MESANGIUM • IgG, IgM, C3 along GMB FOCALLY • 95% full recovery www.freelivedoctor.com
    29. 29. www.freelivedoctor.com
    30. 30. RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS • Clinical definition, NOT a specific pathologic one • “CRESCENTIC” • Anti-GBM Ab • IMMUN CPLX • Anti-Neut. Ab www.freelivedoctor.com
    31. 31. NEPHROTIC SYNDROME • MASSIVE PROTEINURIA • HYPOALBUMINEMIA • EDEMA • LIPIDEMIA/LIPIDURIA • NUMEROUS CAUSES: – MEMBRANOUS, MINIMAL CHANGE, FOCAL SEGMTL. – DIABETES, AMYLOID, SLE, DRUGS www.freelivedoctor.com
    32. 32. MEMBRANOUS GLOMERULONEPHRITIS • Drugs, Tumors, SLE, Infections • Deposition of Ag-Ab complexes • Indolent, but >60% persistent proteinuria • 15% go on to nephrotic syndrome www.freelivedoctor.com
    33. 33. www.freelivedoctor.com
    34. 34. MINIMAL CHANGE GLOM. (LIPOID NEPHROSIS) • MOST COMMON CAUSE of NEPHROTIC SYNDROME in CHILDREN • EFFACEMENT of FOOT PROCESSES www.freelivedoctor.com
    35. 35. FOCAL SEGMENTAL GLOMERULO-SCLEROSIS • Just like its name – Focal – Segmental – Glomerulo-SCLEROSIS (NOT –itis) • HIV, Heroine, Sickle Cell, Obesity • Most common cause of ADULT nephrotic syndrome www.freelivedoctor.com
    36. 36. MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS • MPGN can be idiopathic or 2º to chronic immune diseases Hep-C, alpha-1-antitrypsin, HIV, Malignancies • GBM alterations, subendo. • Leukocyte infiltrations • Predominant MESANGIAL involvement www.freelivedoctor.com
    37. 37. IgA NEPHROPATHY (BERGER DISEASE) • Mild hematuria • Mild proteinuria • IgA deposits in mesangium www.freelivedoctor.com
    38. 38. HEREDITARY HEMATURIA SYNDROMES • ALPORT SYNDROME – Progressive Renal Failure – Nerve Deafness – VARIOUS eye disorder – DEFECTIVE COLLAGEN TYPE IV • THIN GBM (Glomerular Basement Membrane) Disease, i.e., about HALF as uniformly thin as it should be www.freelivedoctor.com
    39. 39. CHRONIC GLOMERULONEPHRITIS • Can result from just about ANY of the previously described acute ones – THIN CORTEX – HYALINIZED (fibrotic) GLOMERULI – OFTEN SEEN IN DIALYSIS PATIENTS www.freelivedoctor.com
    40. 40. SECONDARY (2º) GLUMERULONEPHROPATHIES • SLE • Henoch-Schonlein Purpura (IgA-NEPH) • BACTERIAL ENDOCARDITIS • DIABETES (Nodular Glomerulosclerosis, or K-W Kidney) • AMYLOIDOSIS • GOODPASTURE • WEGENER • MYELOMA www.freelivedoctor.com
    41. 41. www.freelivedoctor.com
    42. 42. TUBULES INTERSTITIUM BLOOD VESSELS OBSTRUCTION TUMORS www.freelivedoctor.com
    43. 43. TUBULAR DISEASES • ACUTE TUBULAR NECROSIS • TUBULOINTERSTITIAL NEPHRITIS – PYELONEPHRITIS • ACUTE • CHRONIC – DRUGS – TOXINS • URATE NEPHROPATHY • HYPERCALCEMIA/NEPHROCALCINOSIS • MULTIPLE MYELOMA www.freelivedoctor.com
    44. 44. ACUTE TUBULAR NECROSIS • Destruction of renal TUBULAR epithelium • Loss of renal function • 50% of ACUTE renal failure • Two types: ISCHEMIC NEPHROTOXIC -AMINOGLYCOSIDES -AMPHOTERICIN B -CONTRAST AGENTS www.freelivedoctor.com
    45. 45. ATN PATHOGENESIS • BLOOD FLOW DISTURBANCES (ISCHEMIC) • TUBULAR INJURY (NEPHROTOXIC) www.freelivedoctor.com
    46. 46. CLINICAL COURSE • INITIATION (36 hours) – Mild OLIGURIA – Mild AZOTEMIA • MAINTENANCE – More OLIGURIA – More AZOTEMIA – DIALYSIS NEEDED • RECOVERY – HYPOKALEMIA main problem – BUN, CREATININE return to normal www.freelivedoctor.com
    47. 47. TUBULO/INTERSTITIAL NEPHRITIS • INFECTIONS, i.e., pyelonephritis • TOXINS, heavy metals, chemo, NSAIDS • METABOLIC, urates, Ca++, Oxalates • PHYSICAL, obstruction, radiation • IMMUNOLOGIC, esp. transplant rejection www.freelivedoctor.com
    48. 48. PYELONEPHRITIS • GI Gram NEGATIVES: E. COLI, Proteus, Klebsiella, Enterobacter, Strep. faecalis, usually “NORMAL” flora • ASCENDING, by FAR, the most common, i.e., reflux, obstruction • HEMATOGENOUS too • ACUTE PYELONEPHRITIS, neutrophils • CHRONIC PYELONEPHRITIS, lymphocytes, scars www.freelivedoctor.com
    49. 49. ACUTE or CHRONIC PYELONEPHRITIS? www.freelivedoctor.com
    50. 50. ACUTE or CHRONIC PYELONEPHRITIS? www.freelivedoctor.com
    51. 51. ACUTE or CHRONIC PYELONEPHRITIS? www.freelivedoctor.com
    52. 52. FACTORS • OBSTRUCTION: Congenital or Acquired • INSTRUMENTATION • VESICOURETERAL REFLUX • PREGNANCY • AGE, SEX, why sex? F>>>M • PREVIOUS LESIONS • IMMUNOSUPPRESION or IMMUNODEFICIENCY www.freelivedoctor.com
    53. 53. DRUGS/TOXINS causing INTERSTITIAL NEPHRITIS • Synthetic Penicillins • Rifampin • Thiazides • 2 weeks later: Fever, eosinophilia, rash, and an acute renal failure type of picture www.freelivedoctor.com
    54. 54. ANALGESIC NEPHROPATHY • ASPIRIN, TYLENOL, NSAIDS – TUBULOINTERSTITIAL NEPHRITIS – PAPILLARY NECROSIS (also Dm & HbS) www.freelivedoctor.com
    55. 55. URATE NEPHROPATHY • Precipitation of Uric Acid Crystals in the TUBULES, especially in a LOWER than usual PH situation (mini- TOPHUS) H & E alcohol fixed POLARIZED LIGHT MICROSCOPY www.freelivedoctor.com
    56. 56. HYPERCALCEMIA NEPHROCALCINOSIS PRINCIPLE:In extreme or uncontrolled or chronic HYPERCALCEMIA, calcium stones form in the tubulo-interstitium of the kidney, which can eventually lead to tubular obstruction and loss of function www.freelivedoctor.com
    57. 57. MULTIPLE MYELOMA • Bence Jones proteinuria (immunoglobulin light chains) • AMYLOIDOSIS www.freelivedoctor.com
    58. 58. VASCULAR DISEASES • BENIGN NEPHROSCLEROSIS • MALIGNANT NEPHROSCLEROSIS (i.e., malignant hypertension) • RENAL ARTERY STENOSIS • THROMBOTIC MICROANGIOPATHIES – Hemolytic-Uremic Syndromes, Child, Adult, TTP • THROMBI, EMBOLI, INFARCTS – SICKLE CELL – DIFFUSE CORTICAL NECROSIS www.freelivedoctor.com
    59. 59. BENIGN NEPHROSCLEROSIS • Sclerosis, i.e., “hyalinization” of arterioles and small arteries, i.e., arterio-, arteriolo- • Is this part of “routine” atherosclerosis???? • VERY VERY VERY common www.freelivedoctor.com
    60. 60. MALIGNANT NEPHROSCLEROSIS (i.e., malignant hypertension) • NOT a part of “routine” atherosclerosis • By definition, associated with rapidly progressive hypertension (1-2% of HTN) • VASCULAR DAMAGE • FIBRINOID NECROSIS • “ONION SKINNING” • SIGNIFICANT LUMENAL NARROWING www.freelivedoctor.com
    61. 61. Renal Artery Stenosis • Rare cause of HTN • SMALL Kidney • 1) Plaque type is usual cause, yes regular old atherosclerosis • 2) Fibromuscular “dysplasia” type: – INTIMAL HYPERPLASIA – MEDIAL HYPERPLASIA – ADVENTITIAL HYPERPLASIA – In younger women www.freelivedoctor.com
    62. 62. PLAQUE, i.e., ATHEROSCLEROSIS FIBROMUSCULAR DYSPLASIA www.freelivedoctor.com
    63. 63. MICROANGIOPATHIES (thrombotic) • Hemolytic-Uremic Syndrome – Familial – Childhood – Adult • TTP (Thrombotic Thrombocytopenic Purpura), IDIOPATHIC www.freelivedoctor.com
    64. 64. MICROANGIOPATHIES COMMON PROCESSES –Hemolysis –Thromboses in renal capillaries –Thrombocytopenia (a “consumption” coagulopathy) –FIBRIN PLUGS www.freelivedoctor.com
    65. 65. OTHER VASCULAR • Atherosclerosis • Atheroemboli • Sickle Cell • Diffuse Cortical Necrosis www.freelivedoctor.com
    66. 66. RENAL INFARCTS • WEDGE SHAPED • WELL DELINEATED • “WHITE” (anemic) INFARCT • Perhaps a little “YELLOW” • HEAL WITH A SCAR www.freelivedoctor.com
    67. 67. www.freelivedoctor.com
    68. 68. OBSTRUCTIONS • UROLITHIASIS • CONGENITAL • PROSTATE ENLARGEMENT • TUMORS • INFLAMMATION • SLOUGHED CLOTS, PAPILLAE • PREGNANCY • NEUROGENIC www.freelivedoctor.com
    69. 69. UROLITHIASIS • CALCIUM (OXALATE or PHOSPHATE) 70% • MAGNESIUM AMMONIUM PHOSPHATE 20% • URIC ACID 10% CA↑↑↑ Bact. U.A. ↑↑↑ www.freelivedoctor.com
    70. 70. TUMORS • BENIGN – Papillary Adenoma – Fibroma/Hamartoma – Angiomyolipoma – Oncocytoma • MALIGNANT – Renal Cell Carcinoma (Clear Cell Carcinoma, Adenocarcinoma, Hypernephroma) – Urothelial (Transitional) www.freelivedoctor.com
    71. 71. RENAL CELL CARCINOMA • TOBACCO RELATED, STRONGLY • SOME HEREDITARY/FAMILIAL • MOST are “CLEAR CELL”, a few PAPILLARY • YELLOW grossly, “CLEAR” cells microscopically • STRONGLY tend to invade the renal VEIN early, in preference to lymphatics. Does the kidney have lymphatics? www.freelivedoctor.com
    72. 72. UROTHELIAL (TRANSITIONAL) RENAL CARCINOMAS • In renal pelvis. Why? • 1/10 as common as renal cell carcinomas • EXACTLY the same appearance as lower urinary tract carcinomas. Why? • MUCH more likely to obstruct the kidney than renal cell carcinomas. Why? • Associated with ureter and bladder carcinomas. Why? www.freelivedoctor.com

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