most of the glomerular diseases , either primary or secondary..touching all the aspects including light microscopy, electron microscopy and immunoflourescence.
most of the glomerular diseases , either primary or secondary..touching all the aspects including light microscopy, electron microscopy and immunoflourescence.
Polycystic disease of the kidney (PKD) is a disorder in which major portion of the renal parenchyma is converted into cysts of varying size .
Fluid-filled cysts distributed over the kidney results in massive enlargement of the kidneys.
This presentation comprises of congenital anomalies of kidney and urinary tract made concise and in depth for PG preparation. It contains all important topics of the regarding subject covered in detail.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
1. Cystic Diseases of the Kidney
Presentor : Dr. Pallavi Prasad
Senior Resident
SGPGIMS
2. Classification of cystic kidney diseases
A. Polycystic kidney disease
B. Renal medullary cysts
C. Cysts in hereditary cancer syndromes
D. Multilocular renal cyst and variants
E. Localized cystic disease
F. Simple cortical cysts
G. Acquired (dialysis-induced) cysts
H. Miscellaneous
3. A) Polycystic kidney disease
1. Autosomal dominant (ADPKD)
a. Classic ADPKD in adults
b. Early-onset ADPKD in children
2. Autosomal recessive (ARPKD)
a. Classic ARPKD in neonates and infants
b. Delayed-onset ARPKD in older children and adults
3. GCKD
a. Primary
b. Secondary
4. B. Renal medullary cysts
1. Nephronopthisis, autosomal recessive
2. Medullary cystic disease , autosomal dominant
a. MCKD 1
b. MCKD 2
c. UROM-associated hyperuricemia
d. Renin
e. HPRT1
f. SLC2A9
3. Medullary sponge kidney
5. C. Cysts in hereditary cancer syndromes
1. Von Hippel-Lindau disease
2. TSC
D. Multilocular renal cyst and variants
E. Localized cystic disease
F. Simple cortical cysts
G. Acquired (dialysis-induced) cysts
7. Renal Cystic Diseases
Sporadic & genetically determined congenital, developmental
& acquired conditions
Cysts in one or both kidneys
Tubules cysts
Different etiologies – similar
Same etiologic entity - wide spectrum of renal abnormalities
10. Autosomal Dominant Polycystic Kidney
Disease (ADPKD)
PKD1 (80-85%); PKD2 (10-15%)
PKD3 - isolated cases, not yet confirmed.
PKD1 : earlier onset of symptoms
PKD2 : delayed cyst formation, hypertension ,ESRD by 10 to
20 years.
Allelic heterogeneity that correlates with variability in
clinical manifestations
11. Relative Frequency of Clinical Manifestations in
ADPKD and age at onset
Clinical Manifestations Frequency (%) Mean Age (Years)
Kidney cysts 100 15-29
Liver cysts 75 [>60 years] 45
Pancreatic cysts 10 47
Intracranial aneurysms 5-10 37
Hypertension 50-75 31
Cardiac valve defects 25 Later in life
13. ADPKD1 ADPKD2
16p13.3 4q13-q23
polycystin1 polycystin2
460-kDa 5.4kb
30 y >50 y
>1 kg 650 gm
More and earlier development Fewer cysts, same growth rate
50 y 70 y
Common, severe Less severe
~8% yes
Men have worse disease
14. Pathology of Classic ADPKD
~2.5 kg each and appear enormous (mean weight 0.150 kg).
Reniform appearance is lost
External surface is distorted by multiple cysts that may contain
clear, turbid, gelatinous, or hemorrhagic fluid
15. Pathology of Classic ADPKD
Cysts vary in size from mm to several cms, randomly distributed
Typically unilocular, oval or spherical
Renal pelvis and calyces cannot be identified, and replacement of the
normal renal parenchyma is usually extensive
Residual renal parenchyma is compressed and eventually becomes
atrophic by the enlarging cysts filled with eosinophilic fluid
Interstitial fibrosis , globally sclerosed glomeruli ; cystic glomeruli
The epithelium lining the cysts is denuded, flat, or hyperproliferative
Micropolyps=90%
19. Tubular epithelial cell proliferation,
apoptosis, fluid accumalation
Gradual luminal dilatation
cyst
Cysts seperate from parent
tubules
Sac-like structure
Lining epithelial cells-autonomous
proliferation
Loss of polarity
Mispolarisation of
proteins(Na-K-ATPase)
Electrolyte transport
proteins into cysts
EGFR
20. Malignancy in ADPKD
> 10x increase of malignancy
Intracystic RCCs -1 to 4 cm
Renal cell carcinomas, clear cell, papillary, or chromophobe
type
Multifocal and bilateral RCC
20% of ADPKD kidneys
21.
22. Early-Onset ADPKD
Develop in utero
Intracystic epithelial micropolyps
Relevant family history-U/L
Genetic analysis may be necessary in ambiguous cases
Early-
Onset
ADPKD
glomerular
cysts
bilaterally
enlarged
kidneys
young
25. 7-year-old boy
Bilateral renal cysts
Concurrent liver cysts
No family history of ADPKD
Biopsy
ADPKD
26. Autosomal Recessive Polycystic Kidney Disease
(ARPKD)
Antenatally/ neonatal period
a/w hepatic fibrosis
30% die of respiratory failure because of lung hypoplasia or
sepsis
Older children - liver symptoms [acute cholangitis to cirrhosis]
Potter's
sequence
bilateral
massive kidney
enlargement
hepatic fibrosis
27. Autosomal Recessive Polycystic Kidney
Disease (ARPKD)
Complications - chronic lung disease, growth retardation,
hyponatremia, UTI
In ARPKD, neither parent has the disease; each child of
parents who are both carriers has a 1:4 chance of
inheriting the disease and 1:2 chance of being a carrier
PKHD1 : 6p21 - fibrocystin/polyductin
29. Autosomal Recessive Polycystic Kidney
Disease (ARPKD)
Diffuse microcysts sponge appearance
diffuse replacement of the renal parenchyma
by cylindrical cysts
30. Autosomal Recessive Polycystic Kidney Disease
(ARPKD)
M/F : cysts involve the collecting ducts and typically extent to
the cortex
Collecting duct dilatation and renal cortical involvement
increase with gestational age
Type of mutation also affects the
extent & time of cyst development
31. Autosomal Recessive Polycystic Kidney Disease
(ARPKD)
Histologic variability prompted some authors to devise a
scoring system –
• extent of collecting duct dilation
• loss of proximal tubules
• cortical involvement
• loss of the nephrogenic zone
grades 1 to 4 were proposed.
35. Glomerulocystic Kidney Disease
GCKD is not one disease but a heterogeneous group
of entities with glomerular cysts as the common
histologic finding
Primary causes
ADPKD PKD1,2
ARPKD PKDH1
GCKD UROM, HNF1β
TSC2
NPHP Infantile
Other ?
Secondary causes
Renal dysplasia sporadic
obstructive
syndromic
Ischemic HUS/TTP
vasculitis
Vascular stenosis
Drug induced
37. Glomerulocystic Kidney Disease
Glomerular cysts involve the Bowman space and sometimes
the origin of the proximal tubule
Focal or diffuse
M/F : majority of glomeruli are cystic but interestingly orderly
arranged in rows
No tubular cysts
Intervening stroma is not fibrotic
38. Glomerulocystic Kidney Disease
UROM mutations and hyperuricemia
Hyperuricemic nephropathies have overlapping symptoms
with infantile or juvenile NPH.
GCKD can also be a feature of NPH
EMA PAX-2
39.
40.
41. Multilocular Renal Cyst (Multilocular
Cystic Nephroma)
<4, >30 yrs
encapsulated and consists of noncommunicating multiloculated
lobules that are filled with gelatinous or clear fluid , single layer of
flat or “hobnail”-appearing cells
50. Medullary sponge kidney
Cysts derived from the collecting ducts, ectatic
ducts in the papillae
Urothelial, columnar or squamous epithelium
IF, II
52. Von Hippel-Lindau Disease
AD
germ-line mutations of the VHL tumor suppressor gene [3p25-26]
high degree of vascularization + clear cell component
at a minimum, one characteristic tumor (CNS hemangioblastoma or clear
cell tumor in a visceral organ) suffices for diagnosis if definitive family
history exists
In the absence of family history, two characteristic (clear cell) tumors are
required for diagnosis.
Kidney cysts =70%
Pancreatic cysts affect 26% of patients, but cysts in the liver are rare.
53. Von Hippel-Lindau Disease
Gross : normal or slightly enlarged
diffuse replacement of the renal parenchyma by multiple cysts
Pancreas, spleen, lungs, bone, and skin
VHL type 1
VHL type 2
54. Von Hippel-Lindau Disease
Gross : small, do not transform the kidneys into the giant organs as in ADPKD
cysts are few in number
Histologically, cysts may be denuded or lined by low epithelium.
Intracystic tumor nodules are typically clear cell type RCC
A lesion in the CNS / spinal cord = hemangioblastoma > RCC
Distinguishing VHL from ADPKD and TSC as well as other hereditary cystic
diseases may at times be difficult ??
For example, cysts primarily in the pancreas are characteristic of VHL. Solid
nodules within cysts are common in VHL and rare in ADPKD. Liver cysts are
rare in VHL in contrast to ADPKD
Distinguishing VHL from adult TSC is easier based on the fact that the most
common tumor is angiomyolipoma, and extrarenal manifestations are distinct
from VHL
55. Pathogenesis
VHL also regulates genes related to cell cycle,
epithelial cell differentiation, and fibronectin
assembly in the ECM
hypoxia-inducible
factor (HIF)-1
hypoxia-inducible
genes
PDGFB, Flik-1, Tie-
2, erythropoietin,
TGFα
56. Tuberous Sclerosis
Systemic phacomatosis
Hamartomatous proliferative lesions
Brain, skin, retina, heart, endocrine glands, digestive system, lung,
and kidney.
Angiomyolipomas, cysts and RCC
Angiomyolipomas are present in approximately 85%, cysts in 45%
60. Simple Cortical Cysts
12% to 25%
Common findings in autopsy of older men
Oval or round with a smooth outline and are filled with clear
or yellow fluid
Originate from the diverticula of the distal convoluted or
collecting tubules
Divericula increase in number with age, probably as a result
of weakening of tubular basement membranes.
61. Simple Cortical Cysts
M/F : empty space, often without lining
surrounded by compressed, fibrotic interstitium
62. Acquired Cystic Kidney Disease
Native kidneys of patients with ESRD treated for uremia with
hemo- or peritoneal dialysis that did not have hereditary cystic
kidney disease prior to dialysis
>= 3 cysts per kidney in a dialysis patient
The number of cysts increases with time on dialysis
>50% of patients develop cysts within 5 years of dialysis and
about 90% by 10 years.
63. Acquired Cystic Kidney Disease
Risk of developing RCC = 40 to 100x (B/L, metastatic)
Gross : >25% of the renal parenchyma
Normal size/slightly smaller
Lined by cuboidal or hobnail epithelial cells arranged in single
or multiple layers
Flat epithelium and micropapillary proliferation forming small
adenomas (<5mm)
Papillary RCC –m/c
66. Miscellaneous Renal Cysts
Present diagnostic difficulty on radiologic examination
and sometimes clinically but rarely require the
pathologist's attention
Pyelocalyceal
diverticuli
perinephric
pseudocysts
hygroma renalis
67. Pyelocalyceal Diverticuli
Circular or ovoid filling defects of the renal pelvis or the calyces
on intravenous pyelogram
children ; solitary
Found incidentally / severe acute flank pain and gross
hematuria or urinary infection
Ureteric bud branches that failed to induce nephrons and/or to
be integrated into the normal tubulocalyceal system.
A/w xanthogranulomatous pyelonephritis
Histologically, the cavity is lined by flat epithelium surrounded
by a thin layer of smooth muscle
Inflammation , squamous metaplasia , calcifications+
68. Perinephric Pseudocysts
Urine accumulation within the perinephric fat
Reactive variably inflamed fibrous tissue and fat without a
lining epithelium
Localized
Blunt trauma to the kidney or a surgical procedure that caused
damage to the renal capsule is the most frequent cause
C/F : flank or abdominal pain or discovered incidentally
69. Hygroma Renalis
Pericalyceal lymphangiomatosis - ectasia of the lymphatics in the
renal capsule
Circumscribed cystic mass that consists of dilated lymphatics
containing eosinophilic fluid, encircles the renal pelvis or extends
to the renal capsule
Kidney enlarged and diffusely cystic ~ polycystic kidneys
Thin fibrous walls lined by endothelial cells
C/F : asymptomatic or experience symptoms of urinary
obstruction
a distinguishing feature from other multiorgan hereditary cysts such as von Hippel-Lindau disease
bilaterally enlarged kidneys with multiple cysts that have varying signal intensity: most cysts have low signal intensity, but hemorrhage, tumors within a cyst, or infection generates a high-intensity signal on CT or MRI
Residual renal parenchyma is compressed by the enlarging cysts and eventually becomes atrophic. Interstitial fibrosis abounds in most specimens (
However, even at end stage, there is significant number of intact-appearing glomeruli, which may explain why these severely distorted kidneys may continue to function for a long time in spite of cyst expansion
Multiple, varying in size, cysts replace the kidney parenchyma. The cysts contain a characteristic dark staining fluid; focal papillary microadenomas (arrow) growing within the cysts are frequent
interstitial fibrosis, tubular atrophy partially preserved glomeruli (one with a glomerular cyst change), and thick interlobular arteries (arrows) between typical tubular cysts filled with eosinophilic fluid.
that epithelial cells lining ADPKD cysts have neoplastic properties
ADPKD in infants and young children is rare, and it may present diagnostic difficulties to radiologists and pathologists alike.
and by sonography they may resemble an infiltrative instead of a cystic process.
In contrast to polycystic kidneys, multicystic dysplastic kidneys are usually smaller or normal in size and tend to regress in early childhood rather than get larger, feature that is distinctly helpful in the clinical differential diagnosis of cystic kidney disease of childhood
Biopsy shows multiple tubular cysts filled with pale fluid; there is no interstitial fibrosis
much less common than ADPKD
polycystic kidney and hepatic disease 1 gene
For example, in the study by Denamur et al., two severe (truncating) ARPKD mutations correlated with diffuse cylindrical cysts
Histologically, cysts derived from the collecting ducts (Denamur grade 3
Denamur system
multiple thin-wall cysts replace the liver parenchyma; the patient was a 56-year-old man with ADPKD. B: Sections show multiple ectatic, angulated, and branching bile ducts (bile duct hamartomas/von Meyenburg complex). (
Recognizing glomerular cysts can be difficult when the glomerular tuft degenerates as the cysts enlarge. Therefore, empty cysts may be misinterpreted as tubular
Glomerular cysts
Cysts are lined by flat or low proliferative epithelium and an adjacent epithelial component (mixed renal epithelial and stromal tumor).
Infantile to esrd-by 2yrs age, adolescnet-by 19 yrs
Differences such as kidney size, frequency of cysts, and extrarenal associations are helpful diagnostic clues.
As a tumor suppressor gene, biallelic VHL inactivation leads to uncontrolled cell growth, neoplastic transformation and overexpression of VEGF in tumor cells and neoangiogenesis.
TSC cysts are lined by proliferating epithelium composed of large eosinophilic cells with atypical nuclei; some cysts are glomerular in origin
TSC cysts in an adult adjacent to (A) angiomyolipoma; (B) a small cyst lined by a single epithelial layer
Enlargement of size and number of cortical cysts was found to increase with age
Simple cortical cyst devoid of epithelial lining located at the cortical surface
Two to seven percent of patients with acquired renal cystic disease develop intracystic RCC
are frequent findings in the same specimen, suggesting a malignant predisposition of the lining epithelial cells.
follow-up of dialysis patients at risk of developing aggressive tumors.
The condition resembles cystic hygroma of the head and neck.
Abdominal CT shows an enlarged right kidney with innumerable, minute cysts; contralateral kidney is normal. The patient was a 35-year-old woman who presented with hematuria. B: Histologically, cysts have thin wall and flat lining.
