SlideShare a Scribd company logo
Renal Pathology
Introduction:
• 150gm: each kidney
• 1700 liters of blood filtered  180 L of G. filtrate 
1.5 L of urine / day.
• Kidney is a retro-peritoneal organ
• Blood supply: Renal Artery & Vein
• One half of kidney is sufficient – reserve
• kidney function: Filtration, Excretion, Secretion,
Hormone synthesis.
Kidney
Location:
Kidney Anatomy:
Renal Pathology Outline
• Glomerular diseases: Glomerulonephritis
• Tubular diseases: Acute tubular necrosis
• interstitial diseases: Pyelonephritis
• Diseases involving blood vessels: Nephrosclerosis
• Cystic diseases
• Tumors
Clinical Syndromes:
• Nephritic syndrome.
– Oliguria, Haematuria, Proteinuria, Oedema.
• Nephrotic syndrome.
– Gross proteinuria, hyperlipidemia,
• Acute renal failure
– Oliguria, loss of Kidney function - within weeks
• Chronic renal failure.
– Over months and years - Uremia
Introduction
• Functions of the kidney:
– excretion of waste products
– regulation of water/salt
– maintenance of acid/base balance
– secretion of hormones
• Diseases of the kidney
– glomeruli
– tubules
– interstitium
– vessels
• Azotemia: ↑ BUN, creatinine
• Uremia: azotemia + more problems
• Acute renal failure: oliguria
• Chronic renal failure: prolonged uremia
Abnormal findings
• Hematuria
• Oliguria
• Azotemia
• Hypertension
Nephritic syndrome
• Massive proteinuria
• Hypoalbuminemia
• Edema
• Hyperlipidemia/-uria
Nephrotic syndrome
Glomerular diseases
– Nephrotic syndrome
• Minimal change disease
• Focal segmental glomerulosclerosis
• Membranous nephropathy
– Nephritic syndrome
• Post-infectious GN
• IgA (immune) nephropathy
Nephrotic Syndrome
• Massive proteinuria
• Hypoalbuminemia
• Edema
• Hyperlipidemia
• Adults: systemic disease (diabetes)
• Children: minimal change disease
• Characterized by loss of foot processes
• Good prognosis
Causes
Minimal change disease
Minimal change disease Normal glumerular structure
Normal glomerulusMinimal change disease
Focal Segmental Glomerulosclerosis
• Primary or secondary
• Some (focal) glomeruli show partial
(segmental) hyalinization
• Unknown pathogenesis
• Poor prognosis
Focal segmental glomerulosclerosis
Membranous Glomerulonephritis
• Autoimmune reaction against unknown renal antigen
• Immune complexes
• Thickened GBM
• Subepithelial deposits
Membranous glomerulonephritis
Nephritic Syndrome
• Hematuria
• Oliguria, azotemia
• Hypertension
• Post-infectious GN, IgA nephropathy
• Immunologically-mediated
• Characterized by proliferative changes and
inflammation
Causes
Post-Infectious Glomerulonephritis
• Child after streptococcal throat infection
• Immune complexes
• Hypercellular glomeruli
• Subepithelial humps
Post-infectious
glomerulonephritis
IgA Nephropathy
• Common!
• Child with hematuria after (URI) Upper
Respiratory Infection
• IgA in mesangium
• Variable prognosis
IgA nephropathy
• Tubular and interstitial diseases
– Inflammatory lesions
• pyelonephritis
Pyelonephritis
• Invasive kidney infection
• Usually ascends from UTI
• Fever, flank pain
• Organisms: E. coli, Proteus
• Women, elderly
• Patients with catheters or mal-formations
• Dysuria, frequency
• Organisms: E. coli, Proteus
Urinary Tract Infection
Acute pyelonephritis with abscesses
Pyelonephritis
Cellular cast
Chronic pyelonephritis
Drug-Induced Interstitial Nephritis
• Antibiotics, NSAIDS
• IgE and T-cell-mediated immune reaction
• Fever, eosinophilia, hematuria
• Patient usually recovers
• Analgesic nephritis is different (bad)
Drug-induced interstitial nephritis
Acute Tubular Necrosis
• The most common cause of ARF!
• Reversible tubular injury
• Many causes: ischemic (shock), toxic (drugs)
• Most patients recover
Acute tubular
necrosis
Benign Nephrosclerosis
• Found in patients with benign hypertension
• Hyaline thickening of arterial walls
• Leads to mild functional impairment
• Rarely fatal
Benign nephrosclerosis
Malignant nephrosclerosis
• Arises in malignant hypertension
• Hyperplastic vessels
• Ischemia of kidney
• Medical emergency
• 5% of cases of hypertension
• Super-high blood pressure, encephalopathy, heart
abnormalities
• First sign often headache, scotomas
• Decreased blood flow to kidney leads to increased
renin, which leads to increased BP!
• 5y survival: 50%
Malignant Hypertension
Malignant
hypertension
Adult Polycystic Kidney Disease
• Autosomal dominant
• Huge kidneys full of cysts
• Usually no symptoms until 30 years
• Associated with brain aneurysms.
Adult polycystic kidney disease
Childhood Polycystic Kidney Disease
• Autosomal recessive
• Numerous small cortical cysts
• Associated with liver cysts
• Patients often die in infancy
Childhood polycystic kidney disease
Medullary Cystic Kidney Disease
• Chronic renal failure in children
• Complex inheritance
• Kidneys contracted, with many cysts
• Progresses to end-stage renal disease
• Tumors
– Renal cell carcinoma
– Bladder carcinoma
Renal Cell Carcinoma
• Derived from tubular epithelium
• Smoking, hypertension, cadmium exposure
• Hematuria, abdominal mass, flank pain
• If metastatic, 5y survival = 5%
Renal cell carcinoma
Bladder Carcinoma
• Derived from transitional epithelium
• Present with painless hematuria
• Prognosis depends on grade and depth of invasion
• Overall 5y survival = 50%
Bladder carcinoma

More Related Content

What's hot

Ulcers of the intestine
Ulcers of the intestineUlcers of the intestine
Ulcers of the intestine
Manoj Madakshira Gopal
 
Surgical Infection. Acute purulent infection of skin & cellular spases
Surgical Infection. Acute purulent infection of skin & cellular spasesSurgical Infection. Acute purulent infection of skin & cellular spases
Surgical Infection. Acute purulent infection of skin & cellular spases
Eneutron
 
Blood vessel pathology
Blood vessel pathologyBlood vessel pathology
Blood vessel pathology
Gopi sankar
 
Lecture 50 chronic inflammation.ppt 4.11.11
Lecture 50  chronic inflammation.ppt 4.11.11Lecture 50  chronic inflammation.ppt 4.11.11
Lecture 50 chronic inflammation.ppt 4.11.11ayeayetun08
 
Chronic inflammation
Chronic inflammationChronic inflammation
Chronic inflammation
Dr Snehal Kosale
 
Inflammation acute + chronic
Inflammation  acute + chronic Inflammation  acute + chronic
Inflammation acute + chronic
Dr Yaseen Khan
 
GASTROINTESTINAL PATHOLOGY
GASTROINTESTINAL PATHOLOGY GASTROINTESTINAL PATHOLOGY
GASTROINTESTINAL PATHOLOGY
Dr Yaseen Khan
 
Liver Failure
Liver FailureLiver Failure
Liver Failure
imrana tanvir
 
PATHOLOGY OF Aneurysms
PATHOLOGY OF AneurysmsPATHOLOGY OF Aneurysms
PATHOLOGY OF Aneurysms
Dr ABU SURAIH SAKHRI
 
Glomerulonephritis and nephrotic syndrome
Glomerulonephritis and nephrotic syndromeGlomerulonephritis and nephrotic syndrome
Glomerulonephritis and nephrotic syndrome
psrvanan
 
Renal pathology lecture5 Nephrotic & Nephritic syndrome. Sufia Husain 2020
Renal pathology lecture5 Nephrotic & Nephritic syndrome. Sufia Husain 2020Renal pathology lecture5 Nephrotic & Nephritic syndrome. Sufia Husain 2020
Renal pathology lecture5 Nephrotic & Nephritic syndrome. Sufia Husain 2020
Sufia Husain
 
CELL INJURY-2 by DR. ROOPAM JAIN
CELL INJURY-2 by DR. ROOPAM JAINCELL INJURY-2 by DR. ROOPAM JAIN
CELL INJURY-2 by DR. ROOPAM JAIN
Dr. Roopam Jain
 
Granulomatous inflammation
Granulomatous inflammation Granulomatous inflammation
Granulomatous inflammation
Spoorthy Gurajala
 
Pathology of Skin - Common Disorders
Pathology of Skin - Common DisordersPathology of Skin - Common Disorders
Pathology of Skin - Common Disorders
Shashidhar Venkatesh Murthy
 
Cell injury and adaptation.pptx
Cell injury and adaptation.pptxCell injury and adaptation.pptx
Cell injury and adaptation.pptx
LAKSHMI S ANAND
 
Chronic inflammation
Chronic inflammationChronic inflammation
Chronic inflammation
pathologydept
 
Cirrhosis
CirrhosisCirrhosis
Cirrhosis
shiji subeesh
 

What's hot (20)

Ulcers of the intestine
Ulcers of the intestineUlcers of the intestine
Ulcers of the intestine
 
Surgical Infection. Acute purulent infection of skin & cellular spases
Surgical Infection. Acute purulent infection of skin & cellular spasesSurgical Infection. Acute purulent infection of skin & cellular spases
Surgical Infection. Acute purulent infection of skin & cellular spases
 
Blood vessel pathology
Blood vessel pathologyBlood vessel pathology
Blood vessel pathology
 
Lecture 50 chronic inflammation.ppt 4.11.11
Lecture 50  chronic inflammation.ppt 4.11.11Lecture 50  chronic inflammation.ppt 4.11.11
Lecture 50 chronic inflammation.ppt 4.11.11
 
Chronic inflammation
Chronic inflammationChronic inflammation
Chronic inflammation
 
Inflammation acute + chronic
Inflammation  acute + chronic Inflammation  acute + chronic
Inflammation acute + chronic
 
GASTROINTESTINAL PATHOLOGY
GASTROINTESTINAL PATHOLOGY GASTROINTESTINAL PATHOLOGY
GASTROINTESTINAL PATHOLOGY
 
Liver Failure
Liver FailureLiver Failure
Liver Failure
 
Glomerular disease with histopathology
Glomerular disease with histopathologyGlomerular disease with histopathology
Glomerular disease with histopathology
 
PATHOLOGY OF Aneurysms
PATHOLOGY OF AneurysmsPATHOLOGY OF Aneurysms
PATHOLOGY OF Aneurysms
 
Glomerular diseases
Glomerular diseases Glomerular diseases
Glomerular diseases
 
Glomerulonephritis and nephrotic syndrome
Glomerulonephritis and nephrotic syndromeGlomerulonephritis and nephrotic syndrome
Glomerulonephritis and nephrotic syndrome
 
Renal pathology lecture5 Nephrotic & Nephritic syndrome. Sufia Husain 2020
Renal pathology lecture5 Nephrotic & Nephritic syndrome. Sufia Husain 2020Renal pathology lecture5 Nephrotic & Nephritic syndrome. Sufia Husain 2020
Renal pathology lecture5 Nephrotic & Nephritic syndrome. Sufia Husain 2020
 
CELL INJURY-2 by DR. ROOPAM JAIN
CELL INJURY-2 by DR. ROOPAM JAINCELL INJURY-2 by DR. ROOPAM JAIN
CELL INJURY-2 by DR. ROOPAM JAIN
 
Granulomatous inflammation
Granulomatous inflammation Granulomatous inflammation
Granulomatous inflammation
 
Nephrotic syndrome
Nephrotic syndromeNephrotic syndrome
Nephrotic syndrome
 
Pathology of Skin - Common Disorders
Pathology of Skin - Common DisordersPathology of Skin - Common Disorders
Pathology of Skin - Common Disorders
 
Cell injury and adaptation.pptx
Cell injury and adaptation.pptxCell injury and adaptation.pptx
Cell injury and adaptation.pptx
 
Chronic inflammation
Chronic inflammationChronic inflammation
Chronic inflammation
 
Cirrhosis
CirrhosisCirrhosis
Cirrhosis
 

Viewers also liked

Renal pathology..at glance
Renal pathology..at glanceRenal pathology..at glance
Renal pathology..at glanceraj kumar
 
Tubulointerstitial nephritis
Tubulointerstitial nephritisTubulointerstitial nephritis
Tubulointerstitial nephritis
Swati Wadhai
 
1. hemodyanamics normal hemostasis- dr. sinhasan- mdzah
1. hemodyanamics  normal hemostasis- dr. sinhasan- mdzah1. hemodyanamics  normal hemostasis- dr. sinhasan- mdzah
1. hemodyanamics normal hemostasis- dr. sinhasan- mdzah
kciapm
 
Thrombosis 13 10-2016
Thrombosis 13 10-2016Thrombosis 13 10-2016
Thrombosis 13 10-2016
pathologydept
 
pyelonephirits
pyelonephiritspyelonephirits
pyelonephirits
vishnu Jatoth
 
Disease affecting tubules and interstitium
Disease affecting tubules and interstitiumDisease affecting tubules and interstitium
Disease affecting tubules and interstitiumessamramdan
 
Professor Peivand Pirouzi: Pathophysiology of the urinary system 2016
Professor Peivand Pirouzi: Pathophysiology of the urinary system 2016Professor Peivand Pirouzi: Pathophysiology of the urinary system 2016
Professor Peivand Pirouzi: Pathophysiology of the urinary system 2016
Pharmaceutical Compliance Inspection unit, Crown College of Canada
 
Inflammatory diseases of the kidney Part 2
Inflammatory diseases of the kidney Part 2Inflammatory diseases of the kidney Part 2
Inflammatory diseases of the kidney Part 2
Thorsang Chayovan
 
Hemostasis in Pathology
Hemostasis in PathologyHemostasis in Pathology
Hemostasis in Pathology
fadziyah zaira
 
4 hemostasis&thrombosis
4 hemostasis&thrombosis4 hemostasis&thrombosis
4 hemostasis&thrombosis
Prasad CSBR
 
Renal pathology (dr magdy ismail) copy
Renal pathology (dr magdy ismail)   copyRenal pathology (dr magdy ismail)   copy
Renal pathology (dr magdy ismail) copyNelly Said
 
Hemostasis
HemostasisHemostasis
Hemostasis
katejohnpunag
 
Normal hemostasis and coagulation
Normal hemostasis and coagulationNormal hemostasis and coagulation
Normal hemostasis and coagulation
wendwesen alemu
 
Diseases of kidney patho lab pics
Diseases of kidney patho lab picsDiseases of kidney patho lab pics
Diseases of kidney patho lab picsMD Specialclass
 
Hemostasis and blood coagulation general pathology
Hemostasis and blood  coagulation general pathologyHemostasis and blood  coagulation general pathology
Hemostasis and blood coagulation general pathology
Siganga Siganga
 
Pyelonephritis csbrp
Pyelonephritis csbrpPyelonephritis csbrp
Pyelonephritis csbrp
Prasad CSBR
 
Class adulteration & evaluation
Class   adulteration & evaluationClass   adulteration & evaluation
Class adulteration & evaluation
prathibha vanitha
 
Nephrotic syndrome and glomerulonephritis
Nephrotic syndrome and glomerulonephritisNephrotic syndrome and glomerulonephritis
Nephrotic syndrome and glomerulonephritis
Jenna Bernia Kim
 
Pylonephritis,seminar presentation..
Pylonephritis,seminar presentation..Pylonephritis,seminar presentation..
Pylonephritis,seminar presentation..Mulualme Nigusie
 

Viewers also liked (20)

Renal pathology..at glance
Renal pathology..at glanceRenal pathology..at glance
Renal pathology..at glance
 
43 renal pathology
43 renal pathology43 renal pathology
43 renal pathology
 
Tubulointerstitial nephritis
Tubulointerstitial nephritisTubulointerstitial nephritis
Tubulointerstitial nephritis
 
1. hemodyanamics normal hemostasis- dr. sinhasan- mdzah
1. hemodyanamics  normal hemostasis- dr. sinhasan- mdzah1. hemodyanamics  normal hemostasis- dr. sinhasan- mdzah
1. hemodyanamics normal hemostasis- dr. sinhasan- mdzah
 
Thrombosis 13 10-2016
Thrombosis 13 10-2016Thrombosis 13 10-2016
Thrombosis 13 10-2016
 
pyelonephirits
pyelonephiritspyelonephirits
pyelonephirits
 
Disease affecting tubules and interstitium
Disease affecting tubules and interstitiumDisease affecting tubules and interstitium
Disease affecting tubules and interstitium
 
Professor Peivand Pirouzi: Pathophysiology of the urinary system 2016
Professor Peivand Pirouzi: Pathophysiology of the urinary system 2016Professor Peivand Pirouzi: Pathophysiology of the urinary system 2016
Professor Peivand Pirouzi: Pathophysiology of the urinary system 2016
 
Inflammatory diseases of the kidney Part 2
Inflammatory diseases of the kidney Part 2Inflammatory diseases of the kidney Part 2
Inflammatory diseases of the kidney Part 2
 
Hemostasis in Pathology
Hemostasis in PathologyHemostasis in Pathology
Hemostasis in Pathology
 
4 hemostasis&thrombosis
4 hemostasis&thrombosis4 hemostasis&thrombosis
4 hemostasis&thrombosis
 
Renal pathology (dr magdy ismail) copy
Renal pathology (dr magdy ismail)   copyRenal pathology (dr magdy ismail)   copy
Renal pathology (dr magdy ismail) copy
 
Hemostasis
HemostasisHemostasis
Hemostasis
 
Normal hemostasis and coagulation
Normal hemostasis and coagulationNormal hemostasis and coagulation
Normal hemostasis and coagulation
 
Diseases of kidney patho lab pics
Diseases of kidney patho lab picsDiseases of kidney patho lab pics
Diseases of kidney patho lab pics
 
Hemostasis and blood coagulation general pathology
Hemostasis and blood  coagulation general pathologyHemostasis and blood  coagulation general pathology
Hemostasis and blood coagulation general pathology
 
Pyelonephritis csbrp
Pyelonephritis csbrpPyelonephritis csbrp
Pyelonephritis csbrp
 
Class adulteration & evaluation
Class   adulteration & evaluationClass   adulteration & evaluation
Class adulteration & evaluation
 
Nephrotic syndrome and glomerulonephritis
Nephrotic syndrome and glomerulonephritisNephrotic syndrome and glomerulonephritis
Nephrotic syndrome and glomerulonephritis
 
Pylonephritis,seminar presentation..
Pylonephritis,seminar presentation..Pylonephritis,seminar presentation..
Pylonephritis,seminar presentation..
 

Similar to 6 renal pathophysiology

Renal pathology i
Renal pathology iRenal pathology i
Renal pathology i
med_students0
 
Glomerular diseases
Glomerular diseasesGlomerular diseases
Glomerular diseases
Natangwe Tangi
 
glomerulonephritis.pdf
glomerulonephritis.pdfglomerulonephritis.pdf
glomerulonephritis.pdf
AnushriSrivastav
 
L87- Renal 111.ppt
L87- Renal 111.pptL87- Renal 111.ppt
L87- Renal 111.ppt
Gowthun
 
Seminar on nephritis, nephrotic syndrome,bladder cancer
Seminar on nephritis, nephrotic syndrome,bladder cancerSeminar on nephritis, nephrotic syndrome,bladder cancer
Seminar on nephritis, nephrotic syndrome,bladder cancer
ligi xavier
 
Hematuria
HematuriaHematuria
Hematuria
abdur razzak
 
Kidney diseases SSS and the ultra structure.pptx
Kidney diseases SSS and the ultra structure.pptxKidney diseases SSS and the ultra structure.pptx
Kidney diseases SSS and the ultra structure.pptx
LeHaRe
 
Glomerular Disease sem.pptx
Glomerular Disease sem.pptxGlomerular Disease sem.pptx
Glomerular Disease sem.pptx
Hussen39
 
Hyperfiltration injury
Hyperfiltration injury Hyperfiltration injury
Hyperfiltration injury
leelakrishnakarri
 
Cirrhosis and Its Complications
Cirrhosis and Its ComplicationsCirrhosis and Its Complications
Cirrhosis and Its Complications
ozererik
 
glumeronephritis-170726155423 (1).pptx
glumeronephritis-170726155423 (1).pptxglumeronephritis-170726155423 (1).pptx
glumeronephritis-170726155423 (1).pptx
IvyNkirote
 
Diseases of Spleen
Diseases of SpleenDiseases of Spleen
Diseases of Spleen
Fadzlina Zabri
 
Glumeronephritis
GlumeronephritisGlumeronephritis
Glumeronephritis
education4227
 
Diseases of the kidney
Diseases of the kidneyDiseases of the kidney
Diseases of the kidney
Dr. Varughese George
 
Early Detection of Chronic Renal Failure
Early Detection of Chronic Renal FailureEarly Detection of Chronic Renal Failure
Early Detection of Chronic Renal Failure
MeghanaRemidi
 
Anesthesia management in chronic kidney diseases
Anesthesia management in chronic kidney diseasesAnesthesia management in chronic kidney diseases
Anesthesia management in chronic kidney diseases
Tenzin yoezer
 
Microalbuminuria in simple way
Microalbuminuria in simple way Microalbuminuria in simple way
Microalbuminuria in simple way
Y Alsfah
 
Renal disease tutorial
Renal disease tutorial Renal disease tutorial
Renal disease tutorial
drpallavip
 
Spleenomegaly & hypersplenism etiology pathogenesis and surgical management
Spleenomegaly & hypersplenism etiology pathogenesis and surgical managementSpleenomegaly & hypersplenism etiology pathogenesis and surgical management
Spleenomegaly & hypersplenism etiology pathogenesis and surgical management
Aravind Endamu
 
CIRRHOSIS OF LIVER.ppt
CIRRHOSIS OF LIVER.pptCIRRHOSIS OF LIVER.ppt
CIRRHOSIS OF LIVER.ppt
tasnim3rdyear
 

Similar to 6 renal pathophysiology (20)

Renal pathology i
Renal pathology iRenal pathology i
Renal pathology i
 
Glomerular diseases
Glomerular diseasesGlomerular diseases
Glomerular diseases
 
glomerulonephritis.pdf
glomerulonephritis.pdfglomerulonephritis.pdf
glomerulonephritis.pdf
 
L87- Renal 111.ppt
L87- Renal 111.pptL87- Renal 111.ppt
L87- Renal 111.ppt
 
Seminar on nephritis, nephrotic syndrome,bladder cancer
Seminar on nephritis, nephrotic syndrome,bladder cancerSeminar on nephritis, nephrotic syndrome,bladder cancer
Seminar on nephritis, nephrotic syndrome,bladder cancer
 
Hematuria
HematuriaHematuria
Hematuria
 
Kidney diseases SSS and the ultra structure.pptx
Kidney diseases SSS and the ultra structure.pptxKidney diseases SSS and the ultra structure.pptx
Kidney diseases SSS and the ultra structure.pptx
 
Glomerular Disease sem.pptx
Glomerular Disease sem.pptxGlomerular Disease sem.pptx
Glomerular Disease sem.pptx
 
Hyperfiltration injury
Hyperfiltration injury Hyperfiltration injury
Hyperfiltration injury
 
Cirrhosis and Its Complications
Cirrhosis and Its ComplicationsCirrhosis and Its Complications
Cirrhosis and Its Complications
 
glumeronephritis-170726155423 (1).pptx
glumeronephritis-170726155423 (1).pptxglumeronephritis-170726155423 (1).pptx
glumeronephritis-170726155423 (1).pptx
 
Diseases of Spleen
Diseases of SpleenDiseases of Spleen
Diseases of Spleen
 
Glumeronephritis
GlumeronephritisGlumeronephritis
Glumeronephritis
 
Diseases of the kidney
Diseases of the kidneyDiseases of the kidney
Diseases of the kidney
 
Early Detection of Chronic Renal Failure
Early Detection of Chronic Renal FailureEarly Detection of Chronic Renal Failure
Early Detection of Chronic Renal Failure
 
Anesthesia management in chronic kidney diseases
Anesthesia management in chronic kidney diseasesAnesthesia management in chronic kidney diseases
Anesthesia management in chronic kidney diseases
 
Microalbuminuria in simple way
Microalbuminuria in simple way Microalbuminuria in simple way
Microalbuminuria in simple way
 
Renal disease tutorial
Renal disease tutorial Renal disease tutorial
Renal disease tutorial
 
Spleenomegaly & hypersplenism etiology pathogenesis and surgical management
Spleenomegaly & hypersplenism etiology pathogenesis and surgical managementSpleenomegaly & hypersplenism etiology pathogenesis and surgical management
Spleenomegaly & hypersplenism etiology pathogenesis and surgical management
 
CIRRHOSIS OF LIVER.ppt
CIRRHOSIS OF LIVER.pptCIRRHOSIS OF LIVER.ppt
CIRRHOSIS OF LIVER.ppt
 

6 renal pathophysiology