Renal Pathology

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    Image of a normal Glomerulus
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    • Glomerulus with TTP (Thrombic thrombocytopenic purpura)
    • Example of small vessel intrinsic renal azotemia
    • Arrows point at little platlet thrombi which are obstructing the capillaries.  Around it is thick and full of cells showing inflammation.
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    • Rapidly Progressive Glomerulonephritis (RPGN)
    • Get crescent formation (made up of WBC's) because of intense inflammation and influx of leukocytes. Destruction of normal glomerular architecture - condences to a tuft.
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    Urine RBC cast from pt. with RPGN
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    • Acute Tubular Necrosis - (ATN)
    • At the top see normal tubular cells with nice brush border.
    • Tubules in the center are filled with stuff which is a cast (which will be a muddy brown cast in urine specimen)
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    Muddy Brown Cast - Urine microscopy slide of ATN
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    • Acute Interstistial Nephritis (AIN)
    • Blue dots are WBC's which have infiltrated the interstitium between the tubules. Causes increased space betweent he tubules. 
    • Will have WBC cast in urine.
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    White-Cell cast from pt. with allergic acute interstitial nephritis.
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    • EM image of MCD (minimal change disease)
    • Classification - Nephrotic
    • Top and bottom photos show effacement of the podocytes.
    • Top Photo - Can see dark condensations of actin (center of photo) these are often confused with immune complex depositions.
    • Bottom photo - in the center, microvilli can be found which are rearrangements of the actin filaments. Can also see large fluid filled vacuoles which are symbolic for diseased podocytes
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    • H&E image of FSGS (Focal and Segmental Glomerulosclerosis)
    • Classification - Nephrotic
    • Can see the pink scar made of collagen in one segment of the glomerulus (like one slice of pizza pie)
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    • H&E image of HIVAN
    • A variant of FSGS
    • Classification - Nephrotic
    • Can see the pink scarring of the glomerulus in addition to proliferation of the podocyts creating a pseudocrescent
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    • H&E of the tubules in HIVAN
    • Virus infects tubules giving rise to dilated tubules called microcysts form of tubular atrophy and contributes to the renal failure
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    • Membranous Nephropathy on H&E
    • Classification - Nephrotic
    • Can see open thickened capillary loops due tot he thickened BM
    • Deposits sometimes visible
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    • Membranous Nephropathy on IF
    • Granular appearance - IgG staining
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    • Membranous Nephropathy on EM
    • Can see large deposits of subepithelial IC's covered by basement membrane. Creates a "Dome and spike" appearance
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    • Post Strep Glomerulonephropathy (PSGN)
    • Classification - Nephritic
    • No open Capillary loops - filled with cells eg. Neutrophil infiltration
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    • IF image from a pt with PSGN
    • See granular deposition of the IC's
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    • PSGN - EM
    • See subepithelial deposits of IC's which look like humps - characteristic of PSGN
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    • IgA Nephropathy H&E
    • classification - Nephritic
    • See mesangial proliferation
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    • IgA Nephropathy - IF
    • Stain for IgA - This is characteristic - only disease with IgA
    • See branches like a tree (shape of mesangium)
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    • IgA Nephropathy - EM
    • See dark grey deposits in the mesangium
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    MPGN - HE
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    • 3 Possibilities
    • 1) Primary - Stains only C3+
    • 2) Secondary - Stains C3 and IgG
    • 3) TMA - does not stain either. Will stain for fibrin though
  24. MPGN - EM
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Renal Pathology
Renal Pathology Slides and Descriptions
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