RENAL DISEASES

Pathology Department
University Surakarta for Medical Sciences
The Nephron
Consists of the glomerulus and its attached
tubules.
The functional unit of the kidney.
Major Renal Syndromes
Acute Nephritic Syndrome
The Nephrotic Syndrome
Rapidly Progressive Glomerulonephritis
Asymptomatic Hematuria or Proteinuria
Major Renal Syndromes (cont)
Acute Renal Failure
Urinary Tract Infection
Nephrolithiasis
Acute Nephritic Syndrome
Sudden onset of hematuria with RBC casts and
renal failure (days - weeks)
Proteinuria (mild to moderate but NOT Nephrotic
Range)
Hypertension
Hallmark Disease: Post Streptococcal
Glomerulonephritis
What is an
RBC cast?
The Nephrotic Syndrome
Proteinuria (>3.5gm/day)
Hypoalbuminemia
Edema
Hyperlipidema
Lipiduria
Rapidly Progressive
Glomerulonephritis
Nephronal hematuria
Renal failure developing over weeks to months
Diffuse glomerular crescent formation.
Asymptomatic Hematuria or
Proteinuria
Hematuria with or without RBC casts and/or
Proteinuria usually <2.0gm/day
NO RENAL FAILURE
NO NEPHROTIC SYNDROME
Acute Renal Failure
Oliguria (<400ml/day)
Rarely anuria
Recent Onset of Azotemia (hours/days)
Post-Renal Causes
Pre-Renal Causes
RENAL CAUSES
RPGN
Acute Neprhitic Syndrome
Chronic Renal Failure
Uremia
Final Common Path of All Chronic Renal
Diseases
Urinary Tract Infection
Bacteriuria and Pyuria
Dysuria, Frequency, Urgency
Pyelonephritis or Cystitis
WBC casts = Pyelonephritis
Fever
Nephrolithiasis
Renal stones
Renal colic - OOOUUUCCCHHH!!
Severe, Crampy Pain in the flank area
Hematuria (Not RBC casts!)
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
Glomerulus
Endothelial cells
Glomerular basement membrane (GBM)
Podocytes - Visceral Epithelial Cell
Mesangial cells and matrix
Parietal epithelium
Bowmans Capsule
Normal Glomerulus PAS
Normal Glomerulus Silver Stain
Normal Glomerulus EM
GBM
Mesangium
Glomerular Basement Membrane
Capillary Space
Endothelium
Urinary Space
GBM
Podocyte
Glomerular Basement Membrane
Podocytes
Glomerular Function
Glomerular filtration
barrier
charge
Pathogenesis of Glomerular Diseases
Immune mechanisms
Non-immune mechanisms
Immune Mechanisms of Glomerular
Disease
Antigen antibody reaction
Antigen - antibody complex deposition
Antibodies reacting in-situ within the glomerulus
Cell mediated immune mechanisms
Circulating Immune Complex Nephritis
Glomerulus is innocent bystander
Antigen is either endogenous or exogenous
Antigen - antibody complexes trapped in
glomeruli.
Role of complement
Circulating Immune Complex Nephritis:
Histologic Manifestations
LM - Cellular proliferation and leukocyte
infiltration
EM - Electron dense deposits
IF - Granular deposits
Immune Complex Nephritis
In-Situ
Antiglomerular basement membrane disease
Antibodies against fixed antigens in the GBM
LM - crescents
IF - linear deposits
Antiglomerular Basement Membrane
Antibodies
Board Hint:
Basement membrane antigen in Good Pastures -
Alpha 3 chain of collagen type 4
Heymanns Nephritis - Membranous
GN
Antigen - Megalin associated with receptor
associated protein
Discontinuous distribution
Granular IF
Immune Complex Nephritis - Planted
Non-glomerular Antigens
Including: Cationic molecules; DNA; Bacterial
products; etc..
IF - granular pattern
Cell Mediated Immune
Glomerulonephritis
Sensitized T-cells are thought to cause glomerular
injury
May account for GN without immune deposits
Mediators of Immune Injury
Glomerular damage - loss of glomerular barrier
function
Manifested by proteinuria and sometimes by
reduced GFR
Complement - Leukocyte Mediated
Mechanism
One Well-Established Pathway!!!
Activation of complement initiates:
Chemotaxis (C5a)
Neutrophil and monocyte infiltration
Neutrophil Activity
Proteases
Reactive oxygen metabolites
Arachidonic acid metabolites
Other Mediators
Cytotoxic antibodies
Macrophages
Platelets
Resident glomerular cells
Fibrin related products
Other Mechanisms of Glomerular
Injury
Epithelial cell injury
X - factors
resulting in epithelial cell detachment
proteinuria
Renal ablation glomerulopathy
fall in GFR
leads to end stage renal failure