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Professor Peivand Pirouzi: Pathophysiology of the urinary system 2016


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Professor peivand pirouzi pathology of the urinary system 2016
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Professor Peivand Pirouzi: Pathophysiology of the urinary system 2016

  1. 1. Pathology of the Urinary System Professor Peivand Pirouzi, Ph.D., M.B.A., C.C.P.E. School of Health Sciences Seneca College of Applied Arts and Technology Toronto, Canada
  2. 2. Normal Urinary Tract
  3. 3. Normal Nephron
  4. 4. Overview of Major Kidney Diseases • Immunologic disorders (e.g., glomerulonephritis) • Metabolic disorders (e.g., diabetic nephropathy) • Circulatory disturbances (e.g., prerenal renal failure) • Bacterial infections (e.g., pyelonephritis – urinary tract infection) • Tumors • Urinary Tract Infection movie 4’
  5. 5. Developmental Disorders • Renal agenesis: bilateral or unilateral • Horseshoe kidney (renal fusion or super kidney) • Polycystic kidney disease (inherited, progressive failure) • Multicystic renal dysplasia (unilateral, dysfunctional kidneys)
  6. 6. Autosomal Polycystic Kidney Disease
  7. 7. Glomerulopathies DIS- -Disseminated intravascular coagulation GN: Glomerulonephritis SLE: systemic lupus erythematosus
  8. 8. Glomerular Diseases •Immunologic diseases: glomerulonephritis •Metabolic diseases: diabetes, amyloidosis* •Circulatory disturbances: hypertension, atherosclerosis, disseminated intravascular coagulation (DIS) * buildup of misfolded proteins known as amyloids
  9. 9. Immune-Mediated Glomerular Diseases: Clinical Presentation • Acute renal failure (RPGN): crescentic glomerulonephritis (GN) • Nephritic syndrome: acute GN, systemic lupus erythematosus (SLE) • Nephrotic syndrome: lipoid nephrosis, membranous nephropathy*, focal segmental glomerulosclerosis** • Isolated hematuria/proteinuria: Berger’s (IgA) disease, SLE • Chronic renal failure: chronic GN *deposition of immune complexes on the glomerular basement membrane (GBM) with GBM thickening **scar tissue in the filtering unit of the kidney
  10. 10. Nephritic Syndrome: Clinical Features • Hematuria • Red blood cell (RBC) casts, dysmorphic/fragmented RBCs in urinary sediment • Oliguria (the production of abnormally small amounts of urine.) • Proteinuria • Hypoalbuminemia • Edema, generalized • Hypertension
  11. 11. Normal Glomerulus by Electron Microscopy (EM)
  12. 12. PoststreptococcalAcute Glomerulonephritis by Electron Microscopy
  13. 13. Acute Glomerulonephritis: Microscopy
  14. 14. Crescentic Glomerulonephritis
  15. 15. Membranous Nephropathy: Light Microscopy
  16. 16. Membranous Nephropathy: Immunofluorescence Microscopy
  17. 17. Membranous Nephropathy: Electron Microscopy
  18. 18. Nephrotic Syndrome: Electron Microscopy
  19. 19. End-Stage Glomerulopathy: Macroscopic Features
  20. 20. End-Stage Glomerulopathy: Microscopic Features
  21. 21. Diabetic Glomerulosclerosis
  22. 22. Urinary Stones • Calcium stones: calcium phosphate or calcium oxalate stones (75%) • Struvite stones (15%) • Uric acid stones (5%) • Cystine stones (1%)
  23. 23. Struvite Stone
  24. 24. Urinary Infections • Pyelonephritis: invasion of kidney • Acute • Chronic Symptoms: Fever, Chills, high WBC • Cystitis: superficial infection • Acute • Chronic Symptoms: Dysurea (Difficult or painful urination) , urgency
  25. 25. Routes of Renal Infection
  26. 26. Chronic Pyelonephritis
  27. 27. Acute Cystitis
  28. 28. Chronic Cystitis
  29. 29. Circulatory Disturbances • Acute tubular necrosis* • Nephroangiosclerosis • Hypertension • ATN: death of tubular epithelial cells that form the renal tubules of the kidneys • ** associated with hypertension; sclerosis of the renalarterioles redu ces blood flow that can lead to kidney failure and heart failure • *** also called renovascular hypertension, is elevated blood pressure caused by kidney disease. It can usually be controlled by blood pressure drugs.
  30. 30. Neoplasms of Urinary Tract • More often malignant than benign • Wilms’ tumor: only neoplasm found in children; all others occur in older adults • Originate from epithelial cells of kidney or urothelium (transitional cell lining of pelvis, ureter, urinary bladder, posterior urethra)
  31. 31. Urinary Tract Tumors • Most important: • Wilms’ tumor • Transitional cell carcinoma • Renal cell carcinoma:
  32. 32. Urinary Tract Tumors (Cont’d)
  33. 33. Renal Cell Carcinoma • Common: 27,000 new cases; 11,000 cancer-related deaths per year in U.S. • No strong risk factors identified • Found in 5% of chronic end-stage kidney disease patients • Occurs in older adults (>50 years) • Prognosis guarded: 50% survive 5 years
  34. 34. Renal Cell Carcinoma: Macroscopic Features
  35. 35. Renal Cell Carcinoma: Microscopic Features
  36. 36. Renal Cell Carcinoma: Clinical Features • Hematuria: most common finding (50%) • Typical triad (hematuria, flank pain, palpable abdominal mass) found only in 10% • Nonspecific symptoms common, often found accidentally (“internist’s tumor”) • Paraneoplastic syndromes: hypercalcemia, erythrocytosis, or amyloidosis (20%)
  37. 37. Wilms’ Tumor • Tumor of infancy, childhood • Composed of immature cells resembling renal blastemal (mass of undifferentiated cells) • Related, in some cases, to deletion or mutation of tumor suppressor gene WT1 • May be familial or bilateral in 10% cases • Good prognosis: surgery + chemotherapy
  38. 38. Carcinoma of Urinary Bladder • Most common cancer of urinary tract: 52,000 new cases per year in the U.S.; 10,000 cancer- related deaths • Most tumors are transitional carcinomas, but may be squamous or adenocarcinomas • Variable prognosis: depends on grade/stage of tumor
  39. 39. Urinary Bladder Carcinoma
  40. 40. Urinary Bladder Carcinoma: Microscopic Features
  41. 41. Urinary Bladder Carcinoma: Clinical Features • Hematuria • Dysuria • Lower abdominal pain • Diagnosis made on urine cytology and cystoscopic biopsy • Grade I tumors localized to mucosa: 98% 5-year survival, but tend to recur • Grade III tumors with metastases: 15% 5-year survival
  42. 42. Bladder Cancer