Workshop nr 20 - Renal PathologY II

Topic
MICROSCOPY-MI
I. Tubulo-interstitial NP
1. Toxic tubulonecrosis
2. Actte suppurative PN
II. Renal Tumors
1. Grawitz Tumors
2. Wilms Tumors
MACROSCOPY.MA
I. Tubulo-interstitial NP
1. Toxictubulonecrosis
2. Acute suPPurative PN
II. Renal tumors
. Grcwitz Tumors
. Wilms Tumors
. Secondarv cancer (metastasis)
MICROSCOPY-MI
I.Tubular and interstitial diseases
l.Toxic tubulonecrosis - acute tubular necrosis
- tubular epithelial necrosis ) is manifested clinically by acute renal failure (ARF)
- causes: toxic or ischemic
- toxic tubular necrosis - nephrotoxic substances: exogenous: heavy metals (Pb, Hg),
organic solvents (CCl4), drugs (Ab, NSAIDs)
MI
e toxic acute tubulonecrosis - the lesions are located in proximal epithelial tubules
)tubular epithelial necrosis
o necrotic epithelial cells have uniform appearance, acidophilic, without nuclei, some
detache and fall in the lumen (epithelial cylinders or casts).
o tubular BM is intact, forming the support for epithelial remaining cell regeneration
. normal glomeruli
2.Inflammatory lesions - Pyelonephritis (PN) ) acute suppurative PN
o inflammatory renal disease of bacterial etiology ) affecting tubules, interstitium and
renal pelvis
o EtioloBy: gram negative bacteria G. coli, less Proteus and Pseudomonas) )they
affect kidney on 2 waYs:
- by ascending way: bladder infection is ascending to the kidney infection is
favored by obstructive lesions of UT -calculi, tumors
- by descending way: kidney infection occurs in septicemia
MI
. interstitial microabscesses containing occasional microbial colonies
. tubular necrosis
. PMNs form leuco citary casts or cylinders in renal tubules
. slomeruli are normal
II.Renal Tumors
2 types of malignant tumors
Renal clear cell carcinoma- Renal adenocarcinoma (Grawitz Tumor)
. origin-renal tubular epithelium
. architecture: various types of growth
Tubular-adenocarcinoma; Papillary; Solid
. cy'tology
tumoral parenchyma-clear polygonal cells with distinct cell membranes,
central and hypercromatic nuclei and clear cytoplasm containing glycogen
or fat
delicate stroma very well vascularized
Nephroblastoma ( Wilms Tumor)
embryonic tumor derived from remaining nefroblastema in the renal pelvis
- the tumor has a triphasic structure
epithelial component (immature glomerular and tubular structures)
stromal component looking as sarcomatous tumor
primitive blastema composed of small cells (metanephric
blastema)
MACROSCOPY-MI
I. Tubulo-interstitial NP
1. Toxic tubulonecrosis-NTA
. kidneys are enlarged, pale, friable (appearance of boiled meat);
. on cut section - the renal cortex is pale, and medulla is congested.
2. Acute suppurative PN
- ascending PNA
. Hyperaemic pielocaliceal mucosa is covered by a purulent exudate
o Suppurative medulary lines radiate toward cortex
o Cortical large abscesses, yellow, irregular, surrounded by an area of
hyperaemia;
o SS - large areas of suppuration confluenting with wedge shape
- descending PNA (pyoemic abscesses)
o affected kidneys are swelled and congested and presents disseminated
microabscesses on the renal surfaces'
. microabscesses appear as yellow nodules, 2 mm in diameter, under
tension, surrounded by an hyperaemic area.
II.Renal tumors
Grawitz T
SE-polar tumoral masses, with false encapsulation, proiemining on kidney cortex
SS - characteristic appeafance, yellow-gray, with areas of necrosis and
hemorrhage
Wilms T
. tumor clearly defined and encapsulated
. SS- white-gray, lobular appearance, with areas of necrosis and hemorrhage; tumor
is bounded by a rim of normal renal parenchyma; renal pelvis is compressed
Secondary cancer (metastasis)- - multiple nodules - rare