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KIDNEY IN SYSTEMIC LUPUS ERYTHEMATOSUS LUPUS NEPHRITIS
WHO classification of Lupus Nephritis <ul><li>CLASS I : Normal by light microscopy </li></ul><ul><li>CLASS II : Mesangial ...
CLASS 2: Mesangial lupus glomerulonephritis <ul><li>Mild increase in mesangial cells and matrix </li></ul>
CLASS 3: Focal proliferative glomerulonephritis <ul><li>Focal and segmental  proliferation of endothelial and mesangial ce...
CLASS 4: Diffuse proliferative glomerulonephritis
Class V : Membraneous glomerulonephritis <ul><li>Diffuse thickening of capillary walls </li></ul><ul><li>Present with neph...
‘ WIRE LOOP’ LESION <ul><li>Massive  subendothelial  immune complex deposits cause  capillary wall thickening </li></ul><u...
Other renal lesions seen in SLE <ul><li>Tubular atrophy </li></ul><ul><li>Interstitial inflammation and fibrosis </li></ul>
Immunofluorescence <ul><li>Granular deposits  containing IgG, IgM, IgA and complement found in </li></ul><ul><ul><li>Mesan...
KIDNEY IN DIABETES MELLITUS DIABETIC NEPHROPATHY
LESIONS <ul><li>GLOMERULAR </li></ul><ul><ul><li>glomerulosclerosis </li></ul></ul><ul><li>TUBULOINTERSTITIAL </li></ul><u...
Glomerular lesions <ul><li>Capillary basement membrane thickening </li></ul><ul><li>Diffuse glomerulosclerosis </li></ul><...
Diffuse glomerlosclerosis (mesangial increase)
Nodular diabetic glomerulosclerosis and arteriolar hyaline thickening.
Silver positive nodules.
Hyaline lesions <ul><li>Nodular glomerulosclerosis is often accompanied by hyaline lesions due to the accumulation of  pla...
a. between glomerular capillary endothelium and GBM  (&quot;fibrin cap&quot;)
b. in the parietal layer of  Bowman's capsule  (&quot;capsular droplet&quot;)
Clinical presentation of glomerular disease in diabetes <ul><li>Proteinuria </li></ul><ul><li>Nephrotic syndrome </li></ul...
Macroscopy <ul><li>Ischaemia can cause overall fine scarring – kidney surface becomes finely granular, with thinning of th...
KIDNEY IN HYPERTENSION
Benign hypertension - macroscopy <ul><li>Slightly small </li></ul><ul><li>Finely granular outer surface, similar to kidney...
Malignant   hypertension - macroscopy <ul><li>Flea bitten kidney </li></ul><ul><ul><li>Surface smooth, with numerous tiny ...
FLEA-BITTEN KIDNEY <ul><li>SEEN IN </li></ul><ul><li>Malignant hypertension </li></ul><ul><li>Infective endocarditis </li>...
Benign hypertension <ul><li>Hypertensive arteriolosclerosis </li></ul><ul><ul><li>Interlobular arteries narrowed by fibroe...
Benign hypertension <ul><li>Hyaline arteriolosclerosis </li></ul>
Malignant   hypertension <ul><li>Vascular and glomerular thrombosis </li></ul>
Malignant   hypertension <ul><li>Fibrinoid necrosis of arterioles </li></ul>
Malignant   hypertension <ul><li>Hyperplastic arteriolitis/ “onion-skinning” </li></ul>
RENAL AMYLOIDOSIS
<ul><li>Commonly AL or AA type </li></ul><ul><li>Present with nephrotic syndrome </li></ul><ul><li>May die of uraemia </li...
Macroscopy <ul><li>Kidney normal size or slightly enlarged </li></ul><ul><li>Firm and pale </li></ul>
<ul><li>If Lugol’s Iodine applied – glomeruli visible as dark brown spots due to amyloid deposits </li></ul><ul><li>Add su...
Microscopy <ul><li>Amyloid is seen as amorphous eosinophilic deposits in the </li></ul><ul><ul><li>Mesangium </li></ul></u...
Microscopy <ul><li>Can obliterate glomerulus completely </li></ul>H & E
Microscopy <ul><li>Congo red stain – red colour </li></ul><ul><li>Apple green birefringence under polarized light </li></u...
GOUTY NEPHROPATHY <ul><li>Uric acid crystals in tubules & interstitium </li></ul><ul><li>TOPHI – needle-shaped uric acid c...
KIDNEY IN MULTIPLE MYELOMA <ul><li>Myeloma cast nephropathy </li></ul><ul><ul><li>Bence-Jones proteins are directly toxic ...
HENOCH-SCHÖNLEIN PURPURA <ul><li>Syndrome common in children following URTI </li></ul><ul><li>Affects the kidney in 1/3 ca...
HENOCH-SCHÖNLEIN PURPURA <ul><li>Microscopy &  immunofluorescence  similar to IgA nephropathy </li></ul><ul><ul><li>Focal ...
Refer : <ul><li>RENAL INFARCTION  </li></ul><ul><ul><li>Predisposing factors / Causes </li></ul></ul><ul><ul><li>Clinical ...
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Sledmhtnamylgoutmyelhsp

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renal involvement in systemic diseases

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Sledmhtnamylgoutmyelhsp

  1. 1. KIDNEY IN SYSTEMIC LUPUS ERYTHEMATOSUS LUPUS NEPHRITIS
  2. 2. WHO classification of Lupus Nephritis <ul><li>CLASS I : Normal by light microscopy </li></ul><ul><li>CLASS II : Mesangial lupus glomerulonephritis </li></ul><ul><li>CLASS III : Focal proliferative glomerulonephritis </li></ul><ul><li>CLASS IV : Diffuse proliferative glomerulonephritis </li></ul><ul><li>CLASS V : Membraneous glomerulonephritis </li></ul><ul><li>CLASS VI : Advanced sclerosing glomerulonephritis </li></ul>
  3. 3. CLASS 2: Mesangial lupus glomerulonephritis <ul><li>Mild increase in mesangial cells and matrix </li></ul>
  4. 4. CLASS 3: Focal proliferative glomerulonephritis <ul><li>Focal and segmental proliferation of endothelial and mesangial cells </li></ul><ul><li>Neutrophil infiltration </li></ul><ul><li>Fibrinoid necrosis </li></ul><ul><li>Capillary thrombosis </li></ul>
  5. 5. CLASS 4: Diffuse proliferative glomerulonephritis
  6. 6. Class V : Membraneous glomerulonephritis <ul><li>Diffuse thickening of capillary walls </li></ul><ul><li>Present with nephrotic syndrome </li></ul>
  7. 7. ‘ WIRE LOOP’ LESION <ul><li>Massive subendothelial immune complex deposits cause capillary wall thickening </li></ul><ul><li>Seen in classes 3, 4 and 5 </li></ul><ul><li>Signify active disease, poor prognosis </li></ul>
  8. 8. Other renal lesions seen in SLE <ul><li>Tubular atrophy </li></ul><ul><li>Interstitial inflammation and fibrosis </li></ul>
  9. 9. Immunofluorescence <ul><li>Granular deposits containing IgG, IgM, IgA and complement found in </li></ul><ul><ul><li>Mesangium </li></ul></ul><ul><ul><li>Along basement membrane </li></ul></ul><ul><ul><li>Or entire glomerulus </li></ul></ul>
  10. 10. KIDNEY IN DIABETES MELLITUS DIABETIC NEPHROPATHY
  11. 11. LESIONS <ul><li>GLOMERULAR </li></ul><ul><ul><li>glomerulosclerosis </li></ul></ul><ul><li>TUBULOINTERSTITIAL </li></ul><ul><ul><li>Acute and chronic pyelonephritis </li></ul></ul><ul><ul><li>Papillary necrosis </li></ul></ul><ul><li>VASCULAR </li></ul><ul><ul><li>Hyaline arteriolosclerosis </li></ul></ul><ul><ul><li>Atheroma in renal arteries </li></ul></ul>
  12. 12. Glomerular lesions <ul><li>Capillary basement membrane thickening </li></ul><ul><li>Diffuse glomerulosclerosis </li></ul><ul><ul><li>Increase in mesangial matrix and mesangial cells </li></ul></ul><ul><ul><li>Maybe seen in old age and hypertension also </li></ul></ul><ul><li>Nodular glomerulosclerosis </li></ul><ul><ul><li>Kimmelstiel-Wilson disease </li></ul></ul><ul><ul><li>More specific to Diabetes </li></ul></ul><ul><ul><li>Nodules of hyaline material in mesangium at periphery of lobules, pushing capillary loops outwards </li></ul></ul>
  13. 13. Diffuse glomerlosclerosis (mesangial increase)
  14. 14. Nodular diabetic glomerulosclerosis and arteriolar hyaline thickening.
  15. 15. Silver positive nodules.
  16. 16. Hyaline lesions <ul><li>Nodular glomerulosclerosis is often accompanied by hyaline lesions due to the accumulation of plasma proteins </li></ul>
  17. 17. a. between glomerular capillary endothelium and GBM (&quot;fibrin cap&quot;)
  18. 18. b. in the parietal layer of Bowman's capsule (&quot;capsular droplet&quot;)
  19. 19. Clinical presentation of glomerular disease in diabetes <ul><li>Proteinuria </li></ul><ul><li>Nephrotic syndrome </li></ul><ul><li>Chronic renal failure </li></ul>
  20. 20. Macroscopy <ul><li>Ischaemia can cause overall fine scarring – kidney surface becomes finely granular, with thinning of the cortex </li></ul>
  21. 21. KIDNEY IN HYPERTENSION
  22. 22. Benign hypertension - macroscopy <ul><li>Slightly small </li></ul><ul><li>Finely granular outer surface, similar to kidney in diabetes </li></ul><ul><li>Cut surface firm and pale </li></ul>
  23. 23. Malignant hypertension - macroscopy <ul><li>Flea bitten kidney </li></ul><ul><ul><li>Surface smooth, with numerous tiny petechial haemorrhages </li></ul></ul><ul><li>May see large cortical infarcts </li></ul>
  24. 24. FLEA-BITTEN KIDNEY <ul><li>SEEN IN </li></ul><ul><li>Malignant hypertension </li></ul><ul><li>Infective endocarditis </li></ul><ul><li>Wegener’s granulomatosis </li></ul><ul><li>RPGN (including Good-Pasteur’s syndrome) </li></ul><ul><li>SLE (type IV) </li></ul><ul><li>Leptospirosis </li></ul><ul><li>Thought to be due to thrombosis or embolism of glomerular capillaries with fibrinoid necrosis, causing tiny haemorrhagic microinfarcts in the cortex </li></ul>
  25. 25. Benign hypertension <ul><li>Hypertensive arteriolosclerosis </li></ul><ul><ul><li>Interlobular arteries narrowed by fibroelastic thickening of intima </li></ul></ul>
  26. 26. Benign hypertension <ul><li>Hyaline arteriolosclerosis </li></ul>
  27. 27. Malignant hypertension <ul><li>Vascular and glomerular thrombosis </li></ul>
  28. 28. Malignant hypertension <ul><li>Fibrinoid necrosis of arterioles </li></ul>
  29. 29. Malignant hypertension <ul><li>Hyperplastic arteriolitis/ “onion-skinning” </li></ul>
  30. 30. RENAL AMYLOIDOSIS
  31. 31. <ul><li>Commonly AL or AA type </li></ul><ul><li>Present with nephrotic syndrome </li></ul><ul><li>May die of uraemia </li></ul>
  32. 32. Macroscopy <ul><li>Kidney normal size or slightly enlarged </li></ul><ul><li>Firm and pale </li></ul>
  33. 33.
  34. 34. <ul><li>If Lugol’s Iodine applied – glomeruli visible as dark brown spots due to amyloid deposits </li></ul><ul><li>Add sulphuric acid – spots turn violet colour </li></ul>
  35. 35. Microscopy <ul><li>Amyloid is seen as amorphous eosinophilic deposits in the </li></ul><ul><ul><li>Mesangium </li></ul></ul><ul><ul><li>Glomerular capillary walls </li></ul></ul><ul><ul><li>Renal vessel walls </li></ul></ul><ul><ul><li>Interstitium </li></ul></ul>
  36. 36. Microscopy <ul><li>Can obliterate glomerulus completely </li></ul>H & E
  37. 37. Microscopy <ul><li>Congo red stain – red colour </li></ul><ul><li>Apple green birefringence under polarized light </li></ul>CONGO RED
  38. 38. GOUTY NEPHROPATHY <ul><li>Uric acid crystals in tubules & interstitium </li></ul><ul><li>TOPHI – needle-shaped uric acid crystals surrounded by foreign-body giant cells, mononuclear cells & fibrosis </li></ul>
  39. 39.
  40. 40. KIDNEY IN MULTIPLE MYELOMA <ul><li>Myeloma cast nephropathy </li></ul><ul><ul><li>Bence-Jones proteins are directly toxic to tubular epithelium </li></ul></ul><ul><ul><li>Combine with Tamm-Horsfall protein under acidic conditions, to form large eosinophilic casts ; these can elicit an inflammatory reaction with foreign-body giant cells </li></ul></ul><ul><li>Renal amyloidosis </li></ul>
  41. 41. HENOCH-SCHÖNLEIN PURPURA <ul><li>Syndrome common in children following URTI </li></ul><ul><li>Affects the kidney in 1/3 cases </li></ul><ul><li>Renal manifestations [more severe in adults] </li></ul><ul><ul><li>Haematuria </li></ul></ul><ul><ul><li>Proteinuria </li></ul></ul><ul><ul><li>Nephrotic syndrome </li></ul></ul><ul><ul><li>RPGN (rare) </li></ul></ul><ul><li>Other manifestations </li></ul><ul><ul><li>Purpuric rash on extensor surface of arms, legs, buttocks </li></ul></ul><ul><ul><li>Abdominal pain, vomiting, intestinal bleeding </li></ul></ul><ul><ul><li>Arthralgia </li></ul></ul>
  42. 42. HENOCH-SCHÖNLEIN PURPURA <ul><li>Microscopy & immunofluorescence similar to IgA nephropathy </li></ul><ul><ul><li>Focal mesangial proliferation </li></ul></ul><ul><ul><li>Diffuse mesangial proliferation </li></ul></ul><ul><ul><li>Crescentic GN </li></ul></ul><ul><ul><li>IgA deposits in mesangium </li></ul></ul><ul><li>Vasculitis not usually seen in the kidney </li></ul>
  43. 43. Refer : <ul><li>RENAL INFARCTION </li></ul><ul><ul><li>Predisposing factors / Causes </li></ul></ul><ul><ul><li>Clinical features </li></ul></ul><ul><ul><li>Macroscopy </li></ul></ul><ul><ul><li>Microscopy </li></ul></ul><ul><li>RENAL LESIONS IN INFECTIVE ENDOCARDITIS </li></ul>

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