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1、 Diseases of urinary systemZhang HongyingHow to learn systemic pathology (pathology of urinary system) ?basic science (anatomy, histology,physiology, immunology)general pathologysystemic pathologyclinic practice *correlations between structural and functional changes (clinicopathologic correlations)
2、 Functions of the kidneysnEliminating metabolic waste productsnRegulating fluid and electrolyte balancenInfluencing acid-base balancenSecreting hormones (prostaglandins, erythropoietin, 1,25- dihydroxycholecalciferol, renin)The nephronThe main functional unit of the kidneyNormal glomerulusOutlinenGl
3、omerulonephritisnTubulointerstitial nephritisnDiseases of the lower urinary tractnTumors of urinary systemEtiology of glomerular diseasesnPrimary(majority):disease process appears to start within the glomerulusnSecondary:disease process is secondary to systemic disease (SLE, vascular diseases, diabe
4、tes mellitus)nHereditary:congenital diseases ( Fabrys disease)Primary glomerulonephritisnkidney is the only or predominant organ Mechanism of glomerular injurynCirculating immune complex nephritisnimmune complex nephritis in situnCell-mediated immunitynOther mechanismsGranular patternImmunofluoresce
5、nce microscopy Linear patternImmunofluorescence microscopyMechanism of glomerular injurynCirculating immune complex nephritisnimmune complex nephritis in situnCell-mediated immunitynOther mechanismsSteps in diagnoses of glomerular lesionsnClinical presentationnRenal biopsyClinical manifestationsnHem
6、aturia (red blood cells in urine)n Proteinuria (protein lost in urine) nOliguria or anuria (no urine flow)nEdema nHypertension nUrinary casts (cell casts, granular casts, hyaline casts)nAzotemia (waste products accumulation)nUremia (with autotoxication symptom)Clinical presentationsnAcute nephritic
7、syndrome: acute onset, blood pressure ，hematuria, proteinuria, edema, azotemianRapidly progressive nephritic syndrome: abrupt or insidious onset of hematuria, proteinuria, anemia and rapidly progressing renal failureGlomerulonephritis Clinical presentationsnNephrotic syndrome: heavy proteinuria, hyp
8、oalbuminemia, sever edema, hyperlipidemia and lipidurianChronic nephritic syndrome: slowly developing renal failure accompanied by proteinuria, hematuria hypertension and uremiaKey facts renal failurenTwo renal syndromes of total renal failure ( acute and chronic renal failure)nTwo main syndromes of
9、 partial renal failure (nephritic syndrome and nephrotic syndrome)nChronic renal failure is irreversible, as it is caused by permanent destruction of nephronsnAcute renal failure sometimes recovers when the damaging stimulus resolvesThe renal biopsynHistological examinationnImmunofluorescence examin
10、ationnElectron microscopic examination The renal biopsynHistological examinationnImmunofluorescence examinationnElectron microscopic examination Primary glomerulonephritisnAcute diffuse proliferative glomerulonephritisnCrescentic glomerulonephritisnMembranous glomerulonephritisnLipoid nephrosisnFoca
11、l segmental glomerulosclerosisnMembranoproliferative glomerulonephritisnIgA nephropathynChronic glomerulonephritisDiffuse proliferative glomerulonephritisnDiffuse, global, acute inflammation of glomeruli is caused by the deposition of immune complexes in glomeruli, stimulated by a preceding infectio
12、nnChildren are more commonly affectedEtiologynPoststreptococcal (most common): onset is 1 -2 weeks after a primary infection with - hemolytic streptococci of group AnNon-streptococcal(less common): a range of bacterial, viral and protozoal infectionsMorphologyGross examinationSwollen with scattered
13、petechiaHistologic featuresnEndothelial cells proliferationnMesangial cells proliferationnNeutrophils infiltrationNormal glomerulusPost-streptococcal glomerulonephritis ImmunofluorescenceGranular depositsSubepithelial “lumps” immune complexes depositionElectron microscopyClinical featuresnSystemic s
14、ymptomsnAcute nephritic syndrome Acute onsetOliguri a EdemaHypertension HematuriaAzotemia Injures of the capillary wallGFR decreaseFluid retentionFluid retention, renin increasewaste products increaseKEY FACTS: Diffuse proliferative glomerulonephritisnCaused by immune complexes in glomerulus, often
15、after streptococcal infectionnCauses nephritic syndrome, with proliferation of endothelium and mesangium and recruitment of neutrophilisnMost cases recover, but a minority may rapidly progress to renal failure or slowly develop chronic renal failureMain types of glomerulonephritisnAcute proliferativ
16、e(poststreptococcal, postinfectious)glomerulonephritisnRapidly progressive (cresentic) glomerulonephritis nChronic glomerulonephritisRapidly progressive glomerulonephrits (RPGN; crescentic glomerulonephritis) nRPGN is a manifestation of severe glomerular injury characterized by the formation of crescent- shaped masses within the Bowmans spacenRPGN occurs in a small percentage of patients with poststreptococcal glomerulonephritis, b
