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CHAPTER 20

CHAPTER 20. KIDNEY. The KIDNEY. Normal Pathology. NORMAL. Blood Vessels Glomeruli Tubules Interstitium. PATHOLOGY. CLINICAL MANIFESTATIONS CONGENITAL CYSTIC GLOMERULAR TUBULES/INTERSTITIUM BLOOD VESSELS OBSTRUCTION TUMORS. CLINICAL MANIFESTATIONS. CONGENITAL. Agenesis

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CHAPTER 20

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  1. CHAPTER20 KIDNEY

  2. The KIDNEY • Normal • Pathology

  3. NORMAL • Blood Vessels • Glomeruli • Tubules • Interstitium

  4. PATHOLOGY • CLINICAL MANIFESTATIONS • CONGENITAL • CYSTIC • GLOMERULAR • TUBULES/INTERSTITIUM • BLOOD VESSELS • OBSTRUCTION • TUMORS

  5. CLINICALMANIFESTATIONS

  6. CONGENITAL • Agenesis • Hypoplasia • Ectopic • Horseshoe

  7. CYSTIC DISEASES • Cystic Renal Dysplasia • Autosomal-Dominant (Adult) Polycystic • Autosomal-Recessive (Childhood) Polycystic • Renal Medulla Cystic Diseases • Acquired (Dialysis) Cystic Disease • “Simple” Cysts

  8. CYSTIC RENAL “DYSPLASIA”

  9. AUTOSOMAL DOMINANT(ADULT) POLYCYSTIC DISEASE

  10. AUTOSOMAL RECESSIVE(CHILD) POLYCYSTIC DISEASE

  11. RENAL MEDULLACYSTIC DISEASES • Medullary Sponge Kidney (MSK) • Nephrolithiasis-Medullary Cystic Disease

  12. ACQUIRED (DIALYSIS)CYSTIC DISEASE

  13. SIMPLE CYSTS

  14. Clinical Manifestations Histologic Changes Pathogenesis Mechanisms of Progression GLOMERULARDISEASES

  15. Acute Glomerulonephritis Rapidly Progressive (Crescentic) Glomerulonephritis Nephrotic Syndrome Membranous Glomerulonephropathy Minimal Change (Lipoid) Nephrosis Focal Segmental Glomerulosclerosis Membranoproliferative Glomerulonephritis GLOMERULARDISEASES (I)

  16. Hereditary Syndromes of Isolated Hematuria Chronic Glomerulonephritis Glomerular Lesions Associated with Systemic Diseases GLOMERULARDISEASES (II)

  17. CLINICAL MANIFESTATIONS

  18. HISTOLOGIC ALTERATIONS • HYPERCELLULARITY • BASEMENT MEMBRANE THICKENING • HYALINIZATION/SCLEROSIS

  19. GLOMERULARPATHOGENESIS (I) • In-Situ Immune Complex Deposition • Anti-GBM (Glomerular Basement Membrane) Antibodies • Heymann Nephritis • “Circulating” Immune Complexes

  20. GLOMERULARPATHOGENESIS (II) • Ab’s to Glomerular Cells • Cell-Mediated Immunity • Alternate Complement Pathway Activation • Epithelial Cell Injury • Mediators: Cells and Soluble

  21. MECHANISMS OFPROGRESSION • Focal Segmental GlomeruloSclerosis (FSGS) • Tubulointerstitial Fibrosis

  22. ACUTEGLOMERULONEPHRITIS • Acute Proliferative • Post-Streptococcal • NON-Streptococcal

  23. RAPIDLY PROGRESSIVE(CRESCENTIC) GLOMERULONEPHRITIS

  24. NEPHROTIC SYNDROME • Pathophysiology • Causes

  25. MEMBRANOUSGLOMERULONEPHROPATHY • Etiology • Pathogenesis • Morphology • Clinical Course

  26. MIMIMAL CHANGE (LIPOID) NEPHROSIS

  27. FOCAL SEGMENTAL GLOMERULOSCLEROSIS • Classification • Types • Morphology • Pathogenesis • HIV-Associated

  28. MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS • Primary • Secondary • IgA Nephropathy (Berger Disease)

  29. HEREDITARYSYNDROMES(ISOLATED HEMATURIA) • Alport Syndrome • Thin Basement Membrane Disease (Benign Familial Hematuria)

  30. CHRONIC GLOMERULONEPHRITIS • Morphology • Dialysis Changes • Uremic Complications • Clinical Course

  31. GLOMERULOPATHIES with SYSTEMIC DISEASES • Systemic Lupus Erythematosos (SLE) • Henoch-Schönlein Purpura • Bacterial Endocarditis • Diabetic Glomerulosclerosis • Diffuse Mesangial Sclerosis • Amyloidosis • Fibrillary and Immunotactoid Glomerulonephritis

  32. TUBULAR/INTERSTITIALDISEASES • Acute Tubular Necrosis (ATN) • Tubulointerstitial Neprhritis

  33. ACUTE TUBULAR NECROSIS(ATN) • Pathogenesis • Morphology • Clinical Course

  34. TUBULOINTERSTITIALNEPHRITIS • Pyelonephritis • Reflux Nephropathy • Drugs/Toxins • Urate Nephropathy • Nephrocalcinosis • Multiple Myeloma

  35. PYELONEPHRITIS • ACUTE • CHRONIC • REFLUX NEPHROPATHY

  36. DRUGS/TOXINS • General Features • Analgesic Nephropathy • NSAIDS • Others • Chinese Herbs Nephropathy

  37. URATENEPHROPATHY

  38. HYPERCALCEMIANEPHROCALCINOSIS

  39. MULTIPLE MYELOMA

  40. BLOOD VESSELDISEASES • “Benign” Nephrosclerosis • “Malignant” Hypertension (Accelerated Nephrosclerosis) • Renal Artery Stenosis • Thrombotic Microangiopathies • Others

  41. BENIGN NEPHROSCLEROSIS

  42. MALIGNANT NEPHROSCLEROSIS • aka, Malignant Hypertension • aka, Accelerated Nephrosclerosis

  43. RENAL ARTERY STENOSIS

  44. THROMBOTIC MICROANGIOPATHIES • Endothelial Injury • Platelet Aggregation • Hemolytic-Uremic Syndromes • Childhood • Adult • Familial • Idiopathic Thrombotic Thrombocytopenic Purpura (TTP)

  45. OTHERVASCULOPATHIES • Atherosclerotic • Atheroembolic • Sickle-Cell Nephropathy • Diffuse Cortical necrosis • Renal Infarcts

  46. OBSTRUCTIVEUROPATHIES • UROLITHIASES (RENAL CALCULI)

  47. TUMORS • BENIGN • MALIGNANT

  48. BENIGN • Papillary (Cortical) Adenoma • Fibroma or Hamartoma(Renomedullary Interstitial Cell Tumor) • Angiomyolipoma • Oncocytoma

  49. MALIGNANT • Renal Cell Carcinoma(Adenocarcinoma) (Hypernephroma) (Clear Cell Carcinoma) • Urothelial (Transitional) Carcinomas

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