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Pathology of Kidney Disorders

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Today is the First Day, of Rest of Your Life...! Pathology of ... Afferent.A DCT Efferent.A. Cap. loops. DCT. Filtration Unit: 1. Fenestrated Endothelium ... – PowerPoint PPT presentation

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Title: Pathology of Kidney Disorders


1
Today is the First Day, of Rest of Your Life...!
2
Pathology of Glomerulonephritis
Dr. Venkatesh Murthy Shashidhar Senior Lecturer
in Pathology
3
Normal Kidney
4
Normal Glomerulus (PAS)
5
Anatomy
Cap. loops
J.G.App.
DCT
Afferent.A DCT Efferent.A
6
Filtration Unit
1. Fenestrated Endothelium 2. Lamina Rara
Interna 3. Lamina Rara Densa 4. Lamina Rara
Externa 5. Podocytes Slit membrane
Capillary Lumen
7
Glomerular Filtration
BLOOD Proteins 3.6nm/70,000MW
Glomerular Capillary Lumen
Plasma - Proteins FILTRATE
Bowmans Capsule Space
8
Pathogenesis
  • Immune mechanisms Most common
  • Autoimmune
  • Planted Antigen
  • Immune complex.
  • Toxins
  • Metabolic

9
Glomerular diseases
10
Pathogenesis of Immune GN
  • Ab, Ag/Ab or Immune complex deposition.
  • Immune reaction
  • Inflammation Activation of complement
  • destruction of glomerular structure
  • Renal dysfunction, Proteinuria, Hematuria

11
Immune Glomerulonephritis
12
Glomerular damage - patterns
13
Immune Glomerulonephritis
  • In-Situ immune complex formation
  • Tissue antigens - Goodpasture anti GBM Ag
  • Planted antigens - infections, toxins, drugs.
  • Circulating immune complex deposition.
  • Endogenous - DNA as in SLE
  • Exogenous - infections.
  • Cell mediated Immune injury

14
Immune Glomerulonephritis
C.Immune Complex ANTI-GBM
HEYMANN
15
Clinical Syndromes
  • Nephritic syndrome.
  • Oliguria, Haematuria, Proteinuria, Oedema.
  • Nephrotic syndrome.
  • Gross proteinuria, hyperlipidemia,
  • Acute renal failure (RPGN).
  • Oliguria, loss of Kidney function - within weeks
  • Chronic renal failure.
  • Over months and years - Uremia

16
Nephritic Syndromes
  • Diffuse Proliferative GN
  • Post Streptococcal.
  • Rapidly Progressive GN (or Crescentic)
  • Post Streptococcal, Goodpastures,
  • Focal Glomerulonephritis
  • Primary Bergers disease (IgA Nephritis)
  • Secondary IgA nephritis, Henoch Schonlein
    purpura, SBE, Coeliac Disease etc.

17
Post Streptococcal GN (Prol.GN)
  • 1-4 weeks following streptococcal infection
    (nephritogenic strains)
  • Immune mediated (time for Ab formation)
  • Granular deposits of IgG,IgM C3 in GBM,
    (subepithelial location common)
  • Humps in GBM on EM or IF Microscopy

18
Pathogenesis of Diffuse PGN
  • Streptococcal infection - Immune complex
    deposition, inflammation proliferation.
  • Glomerular capillary obstruction
  • J.G.A stimulation Renin high blood pressure
  • Reduced filtration raised blood urea
  • Fluid retention Oedema
  • Damage to GBM
  • Unselective proteinuria (form Pr. casts in
    tubule)
  • Haematuria (form RBC casts in tubule)

19
Progression of DPGN
Focal segmental glomerulo sclerosis
  • Poststreptococcal DPGN

Complete Healing
Tubulo Interstitial Damage
CGN
20
Clinical Features G.Nephritis
  • Hypertension
  • Skin Infections
  • Congestive Cardiac Failure

21
Laboratory Features G.Nephritis
  • Inflammation
  • Decreased filtration
  • Damage to filtration unit

22
Diffuse Proliferative GN
  • Hyperplasia of epithelium endothelium.
  • Cell Swelling.
  • Inflammatory cells.
  • Obstruction to flow.
  • Enlarged hypercellular glomeruli.

23
  • Normal
  • Proliferative
  • Post strepto

24
IF- Diffuse Proliferative GN
25
Complications
26
Glomerular diseases
27
Chronic Glomerulonephritis
28
Urine Microscopy
  • Cells Casts Crystals.
  • Casts are formed within nephron.
  • Casts Suggest Kidney pathology.
  • Casts can be made up of Protein, lipid, cells or
    mixed.
  • Crystals suggest high concentration or altered
    solubility.

29
Formation of Casts
30
Red cell Casts in Urine
31
The greatest test of courage is to bear defeat
without losing heart…! Robert G. Ingersoll
32
Glomerular diseases
33
Minimal Change/Lipoid
34
Minimal Change Disease
Loss of Foot processes
35
Membranous GN
36
Crescentic GN - (RPGN)
37
Crescentic GN - (Trichrome Stain)
38
Goodpasture Syndrome
39
Membranous GN
40
Focal Segmental Gl. Sclerosis
41
Mesangiocapillary GN (MPGN)
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