Renal pathology

FUNDAMENTALS OF RENAL PATHOLOGY

Renal pathology is a subspecialty of anatomic pathology that deals with the diagnosis and characterization of medical diseases (non-tumor) of the kidneys.

In the academic setting, renal pathologists work closely with nephrologists and transplant surgeons, who typically obtain diagnostic specimens via percutaneous renal biopsy.

The renal pathologist must synthesize findings from light microscopy, electron microscopy, and immunofluorescence to obtain a definitive diagnosis.

Medical renal diseases may affect the glomerulus, the tubules and interstitium, the vessels, or a combination of these compartments.

NORMAL HISTOLOGY

THE GLOMERULUS

Typical stains used in renal evaluating renal biopsy

ELECTRON MICROGRAM

Clinical Presentations of Glomerular Diseases

symptomatic proteinuria

•nephrotic syndrome

(proteinuria, hypoproteinemia, lyperlipidemia, edema)

•asymptomatic hematuria

•glomerulonephritis

(hematuria, proteinuria, hypertension, renal failure)

•acute glomerulonephritis

(neprhitis with short term renal failure)

•crescentic glomerulonephritis

(nephritis with rapidly progressive renal failure)

•chronic glomerulonephritis

(chronic progression of renal failure)

•End Stage Renal Disease

(irreversible renal failure)

The Nephrotic Syndrome

The nephrotic syndrome is characterized by massive proteinuria, which leads to hypoproteinemia/hypoalbunemia, hyperlipidemia with elevated cholesterols, triglicerides and other lipids, and edema.

The edema results not only from the hypoosmolar state caused by the loss of plasma proteins, but also from abnormal salt and water retention.

Histologic feature that is found in any patient with nephrotic range proteinuria no matter what the cause

OVAL FAT BODIES

Minimal Change Glomerulopathy

IF

ULTRA STRUCTURE

Membranous Glomerulopathy

H&E

SPECIAL STAINS

IA

L STAINS

ELECTRON MICROGRAM

IF

Focal Segmental Glomerulosclerosis

H&E

IF

Type I Membranoproliferative (Mesangiocapillary) Glomerulonephritis

IF

ELECRON MICRGRAM

IF

ELECTRON MICROGRAM

Type II Membranoproliferative Glomerulonephritis, (Dense Deposit Disease)

ELECTRON MICROGRAM

IF

REFFERENCE

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