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RENAL DISEASES

Pathology DepartmentUniversity Surakarta for Medical Sciences

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The Nephron

Consists of the glomerulus and its attached

tubules.

The functional unit of the kidney.

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Major Renal Syndromes

Acute Nephritic Syndrome

The Nephrotic Syndrome

Rapidly Progressive Glomerulonephritis Asymptomatic Hematuria or Proteinuria

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Major Renal Syndromes (cont)

Acute Renal Failure

Urinary Tract Infection

Nephrolithiasis

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Acute Nephritic Syndrome

Sudden onset of hematuria with RBC casts and

renal failure (days - weeks)

Proteinuria (mild to moderate butNOT Nephrotic

Range)

Hypertension

Hallmark Disease: Post Streptococcal

Glomerulonephritis

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What is an

RBC cast?

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The Nephrotic Syndrome

Proteinuria (>3.5gm/day)

Hypoalbuminemia

Edema Hyperlipidema

Lipiduria

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Rapidly Progressive

Glomerulonephritis

Nephronal hematuria

Renal failure developing over weeks to months

Diffuse glomerular crescent formation.

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Asymptomatic Hematuria or

Proteinuria

Hematuria with or without RBC casts and/or

Proteinuria usually

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Acute Renal Failure

Oliguria (

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Chronic Renal Failure

Uremia

Final Common Path of All Chronic Renal

Diseases

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Urinary Tract Infection

Bacteriuria and Pyuria

Dysuria, Frequency, Urgency

Pyelonephritis or Cystitis

WBC casts = Pyelonephritis

Fever

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Nephrolithiasis

Renal stones

Renal colic - OOOUUUCCCHHH!!

Severe, Crampy Pain in the flank area

Hematuria (NotRBC casts!)

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Glomerular Diseases

An important cause of chronic renal failure

Renal Syndromes related to Glomerular Diseases

Acute Nephritic Syndrome

Nephrotic Syndrome

Rapidly Progressive Glomerulonephritis

Asymptomatic Hematuria or Proteinuria

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Glomerulus

Endothelial cells

Glomerular basement membrane (GBM)

Podocytes - Visceral Epithelial Cell

Mesangial cells and matrix

Parietal epithelium

Bowmans Capsule

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Normal Glomerulus PAS

Normal Glomerulus Silver Stain

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Normal Glomerulus Silver Stain

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Normal Glomerulus EM

GBM

Mesang

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Glomerular Basement Membrane

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Glomerular Basement Membrane

Podocytes

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Glomerular Function

Glomerular filtration

barrier

charge

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Pathogenesis of Glomerular Diseases

Immune mechanisms

Non-immune mechanisms

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Circulating Immune Complex Nephritis

Glomerulus is innocent bystander

Antigen is either endogenous or exogenous

Antigen - antibody complexes trapped in

glomeruli.

Role of complement

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Circulating Immune Complex Nephritis:

Histologic Manifestations

LM - Cellular proliferation and leukocyte

infiltration

EM - Electron dense deposits

IF - Granular deposits

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Immune Complex Nephritis

In-Situ

Antiglomerular basement membrane disease

Antibodies against fixed antigens in the GBM LM - crescents

IF - linear deposits

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Antiglomerular Basement Membrane

Antibodies

Board Hint:

Basement membrane antigen in Good Pastures -Alpha 3 chain of collagen type 4

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Heymanns Nephritis - Membranous

GN

Antigen - Megalin associated with receptor

associated protein

Discontinuous distribution

Granular IF

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Immune Complex Nephritis - Planted

Non-glomerular Antigens

Including: Cationic molecules; DNA; Bacterial

products; etc.. IF - granular pattern

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Cell Mediated Immune

Glomerulonephritis

Sensitized T-cells are thought to cause glomerular

injury

May account for GN without immune deposits

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Mediators of Immune Injury

Glomerular damage - loss of glomerular barrier

function

Manifested by proteinuria and sometimes by

reduced GFR

Complement - Leukocyte Mediated

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Complement Leukocyte Mediated

Mechanism

One Well-Established Pathway!!!

Activation of complement initiates:

Chemotaxis (C5a)

Neutrophil and monocyte infiltration

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Neutrophil Activity

Proteases

Reactive oxygen metabolites

Arachidonic acid metabolites

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