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Pathology Practical VI: Pathology of urinary disea


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Hypertensive nephrosclerosis histology
Interlobular artery intima (↑fibrous tissue deposition) and media (muscle hypertrophy) thickening -> ↓Lumen size -> ischemia -> Hyaline membrane and periglomerular fibrosis, tubular atrophy, lymphocyte infiltrate, shrunken glomerulus
Lupus nephritis
A variety of histological findings (6 different class), can cause secondary membranous nephropathy, MPGN pattern, Or mixture pattern
Lupus nephritis histology
Lobules in glomerulus, mesangial proliferation, effaced podocyte, splitting of GBM
Acute pyelonephritis
Large amount of inflammatory cells (neurophils) mainly in interstitial of tubules and medulla
Autosomal recessive polycystic diseases (pedi)
Elongated cyst perpendicular to cortical
Renal TB
Yellowish cheese like material with multiple cavities
Anti-GBM glomerulonephritis
Linear under direct immunofluorescence and cellular crescent
Anti-GBM glomerulonephritis RX
Plasma phoresies/ exchange + immunosuppressants (steroid) + supportive Rx
Anti-GBM glomerulonephritis Prognosis
Poor due to poor regenerative capacity of glomerulus
Bilateral hydronephrosis, chronic pyelonephritis
The renal cortex and medulla are markedly but variably thinned out. The renal parenchyma is atrophic. The atrophic renal tissue at the dilated renal calyces has been largely replaced by fibrous tissue
chronic pyelonephritis
There are irregular rough areas on the dilated pelvic surface. Normally the pelvis is lined by urothelium. In this case, the process of chronic inflammation has resulted in fibrosis and infiltration by chronic inflammatory cells such as lymphocytes and plasma cells.
Pyonephrosis
a complication of pyelonephritis in which there is prominent degree of obstruction of the urinary tract. The pelvis, calyces and ureter above the point of obstruction fill with purulent exudate. Pus is also present in the renal parenchyma (also lost during processing). Persistent acute infection -> chronic inflammation -> granulation tissue -> fibrosis
dilated bladder
signify that the bladder may be flaccid, or that there has been bladder outflow obstruction. The latter predisposes the patient to vesicoureteric reflux and the development of kidney scars.
chronic pyelonephritis Histology
Many glomeruli are sclerosed, extensive atrophy of tubules (tubules of small size, tubular cells losing features of differentiation, thickening of tubular BM) and interstitial fibrosis. Some tubules show cystic dilatation (obvious even at very low magnification). A variable degree of mononuclear inflammatory cellular infiltrate in the interstitial tissue is also present. The arterioles are hyalinized and narrowed (need to see at high magnification).