Renal pathology for web

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Information about Renal pathology for web
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Published on February 25, 2008

Author: Ubert

Source: authorstream.com

Slide1:  Renal Pathology Kristine Krafts, M.D. October 16, 2007 Slide3:  $2,500,000 Slide4:  “Like blood, urine is rich in DNA. The Oxidations are portraits of Victor. They're also self-portraits and portraits of assistant Ronnie Cutrone. Doggedly marked territories, they trace signs of identity, even if that identity is unknown (or unknowable).” - Bruce Haines (Art Critic) Slide5:  “Art is what you can get away with.” - Andy Warhol Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Introductory Stuff:  Introductory Stuff Functions of the kidney: excretion of waste products regulation of water/salt maintenance of acid/base balance secretion of hormones Diseases of the kidney glomeruli tubules interstitium vessels Slide10:  Azotemia:  BUN, creatinine Uremia: azotemia + more problems Acute renal failure: oliguria Chronic renal failure: prolonged uremia Introductory Stuff Slide11:  Introductory Stuff Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy Nephritic syndrome Postinfectious GN IgA nephropathy Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Nephrotic Syndrome:  Nephrotic Syndrome Massive proteinuria Hypoalbuminemia Edema Hyperlipidemia, lipiduria Nephrotic Syndrome:  Nephrotic Syndrome Adults: systemic disease (diabetes) Children: minimal change disease Characterized by loss of foot processes Causes Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Minimal Change Disease:  Minimal Change Disease #1 cause of nephrotic syndrome in children Loss of foot processes Pathogenesis unknown Good prognosis Things you must know Slide24:  Minimal change disease Slide25:  Normal glomerulus Slide26:  Minimal change disease Slide27:  Minimal change disease Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Focal Segmental Glomerulosclerosis:  Focal Segmental Glomerulosclerosis Primary or secondary Some (focal) glomeruli show partial (segmental) hyalinization Unknown pathogenesis Poor prognosis Things you must know Slide30:  Focal segmental glomerulosclerosis Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous glomerulonephritis Membranous Glomerulonephritis:  Membranous Glomerulonephritis Autoimmune reaction against unknown renal antigen Immune complexes Thickened GBM Subepithelial deposits/spikes Things you must know Slide33:  Membranous glomerulonephritis Slide34:  Membranous glomerulonephritis Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous glomerulonephritis Nephritic syndrome Nephritic Syndrome:  Nephritic Syndrome Hematuria Oliguria, azotemia Hypertension Nephritic Syndrome:  Nephritic Syndrome Post-infectious GN, IgA nephropathy Immunologically-mediated Characterized by proliferative changes and inflammation Causes Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous glomerulonephritis Nephritic syndrome Postinfectious GN Post-Infectious Glomerulonephritis:  Post-Infectious Glomerulonephritis Child after strep throat Immune complexes Hypercellular glomeruli Subepithelial humps Things you must know Post-Infectious Glomerulonephritis:  Post-Infectious Glomerulonephritis “Sore throat, face bloat, pee coke” Mnemonic Slide41:  Post-infectious glomerulonephritis Slide42:  Post-infectious glomerulonephritis Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous glomerulonephritis Nephritic syndrome Postinfectious GN IgA nephropathy IgA Nephropathy:  IgA Nephropathy Common! Child with hematuria after URI IgA in mesangium Variable prognosis Things you must know Slide45:  IgA nephropathy Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Inflammatory lesions pyelonephritis drug-induced interstitial nephritis Toxic/ischemic lesions Acute tubular necrosis Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Inflammatory lesions pyelonephritis Pyelonephritis:  Pyelonephritis Invasive kidney infection Usually ascends from UTI Fever, flank pain Organisms: E. coli, Proteus Things you must know Slide49:  Acute pyelonephritis with abscesses Slide50:  Pyelonephritis Slide51:  Pyelonephritis Slide52:  Cellular cast Pyelonephritis:  Pyelonephritis Women, elderly Patients with catheters or malformations Dysuria, frequency Organisms: E. coli, Proteus Urinary Tract Infection Pyelonephritis:  E. coli uncomplicated complicated Pyelonephritis UTI: Causative Organisms Slide56:  Urinary catheter colonized by Proteus Slide57:  Chronic pyelonephritis Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Inflammatory lesions pyelonephritis drug-induced interstitial nephritis Drug-Induced Interstitial Nephritis:  Drug-Induced Interstitial Nephritis Antibiotics, NSAIDS IgE and T-cell-mediated immune reaction Fever, eosinophilia, hematuria Patient usually recovers Analgesic nephritis is different (bad) Things you must know Slide60:  Drug-induced interstitial nephritis Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Inflammatory lesions pyelonephritis drug-induced interstitial nephritis Toxic/ischemic lesions Acute tubular necrosis Acute Tubular Necrosis:  Acute Tubular Necrosis The most common cause of ARF! Reversible tubular injury Many causes: ischemic (shock), toxic (drugs) Most patients recover Things you must know Slide63:  Acute tubular necrosis Slide64:  Acute tubular necrosis Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Benign nephrosclerosis Malignant nephrosclerosis Benign Nephrosclerosis:  Benign Nephrosclerosis Found in patients with benign hypertension Hyaline thickening of arterial walls Leads to mild functional impairment Rarely fatal Things you must know Slide67:  Benign nephrosclerosis Malignant nephrosclerosis:  Malignant nephrosclerosis Arises in malignant hypertension Hyperplastic vessels Ischemia of kidney Medical emergency Things you must know Malignant nephrosclerosis:  Malignant nephrosclerosis 5% of cases of hypertension Super-high blood pressure, encephalopathy, heart abnormalities First sign often headache, scotomas Decreased blood flow to kidney leads to increased renin, which leads to increased BP! 5y survival: 50% Malignant Hypertension Slide70:  Malignant hypertension Slide71:  Malignant hypertension Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Adult polycystic kidney disease Childhood polycystic kidney disease Medullary cystic disease Adult Polycystic Kidney Disease:  Adult Polycystic Kidney Disease Autosomal dominant Huge kidneys full of cysts Usually no symptoms until 30s Associated with brain aneurysms Things you must know Slide74:  Adult polycystic kidney disease Childhood Polycystic Kidney Disease:  Childhood Polycystic Kidney Disease Autosomal recessive Numerous small cortical cysts Associated with liver cysts Patients often die in infancy Things you must know Slide76:  Childhood polycystic kidney disease Medullary Cystic Kidney Disease:  Medullary Cystic Kidney Disease Chronic renal failure in children Complex inheritance Kidneys contracted, with many cysts Progresses to end-stage renal disease Things you must know Renal Pathology Outline:  Renal Pathology Outline Introductory stuff Glomerular diseases Tubular and interstitial diseases Diseases involving blood vessels Cystic diseases Tumors Renal cell carcinoma Bladder carcinoma Renal Cell Carcinoma:  Renal Cell Carcinoma Derived from tubular epithelium Smoking, hypertension, cadmium exposure Hematuria, abdominal mass, flank pain If metastatic, 5y survival = 5% Things you must know Slide80:  Renal cell carcinoma Slide81:  Renal cell carcinoma Slide82:  Renal cell carcinoma Bladder Carcinoma:  Bladder Carcinoma Derived from transitional epithelium Present with painless hematuria Prognosis depends on grade and depth of invasion Overall 5y survival = 50% Things you must know Slide85:  Bladder carcinoma

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