Urinary Tract

Pathology Lab

By the Name of Allah,

The Most Gracious, The Most Merciful

2

Kidney & Urinary tract

3

Normal glomerulus by LM.

The glomerular capillary loops are thin and delicate.

Endothelial and mesangial cells are normal in number. The

surrounding tubules are normal.

5

IF-Granula deposition of immune complexes .

characteristic of circulating and in situ immune complex

deposition

6

immunofluorescence linear deposition of

immune complexes

7

IF- linear deposition of immune complexes ,

characteristic of classic anti-GBM antibody GN

8

Minimal change

disease.

A

Under the light

microscope the

PAS-stained

glomerulus

appears normal,

with a delicate

basement

membrane

B

Schematic diagram

illustrating diffuse

effacement of foot

processes of

podocytes with no

immune deposits.

9

MCD-EM

the capillary loop in the lower half contains two electron dense RBC's.

Fenestrated endothelium is present and the BM is normal.

The overlying epithelial cell foot processes are fused (arrows).

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focal and segmental glomerulosclerosis (PAS stain).

a mass of scarred, obliterated capillary lumens with accumulations of

matrix material

11

FSGS

blue collagen deposition (MT stain).

FSGS

effacemant of foot processes

13

LM- membranous glomerulonephritis in which the

capillary loops are thickened and prominent, but the

cellularity is not increased

14

Membranous nephropathy.

A ,Diffuse thickening of the glomerular

basement membrane .

B ,Schematic diagram illustrating

subepithelial deposits, effacement of

foot processes, and the presence of

"spikes" of basement membrane

material between the immune deposits .

15

A silver stain of the glomerulus highlights the proteinaceous basement

membranes in black. There are characteristic "spikes" seen with

membranous glomerulonephritis seen here in which the black basement

membrane material appears as projections around the capillary loops.

16

MGN

IF-deposits of mainly IgG and complement collect in the basement

membrane and appear in a diffuse granular pattern

17

EM-the darker electron dense immune deposits

are seen scattered within the thickened

basement membrane .

18

Membranoproliferative GN, showing mesangial cell proliferation,

basement membrane thickening, leukocyte infiltration, and accentuation

of lobular architecture.

19

Schematic representation of patterns in the two types of membranoproliferative GN.

In type I there are subendothelial deposits;

type II is characterized by intramembranous dense deposits (dense-deposit disease).

In both, mesangial interposition gives the appearance of split basement membranes when

viewed by light microscopy.

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membranoproliferative

glomerulonephritis (MPGN(

21

This silver stain demonstrates a double contour of the basement

membranes("tram-tracking" )that is characteristic of

(MPGN)(arrows).

22

IF Granular deposition of immune complexes

characteristic of circulating and in situ immune

complex deposition

23

EM-MPGN type I a mesangial cell at the lower left that is

interposing its cytoplasm at the arrow into the basement

membrane leading to splitting" of the GBM (tram track).

24

EM-dense deposits in the basement membrane of MPGN type II.

There are dark electron dense deposits within the basement

membrane that often coalesce to form a ribbon-like mass of

deposits ) arrows)

25

Post-streptococcal glomerulonephritis.

This glomerulus is hypercellular and capillary loops

are poorly defined.

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Post-streptococcal glomerulonephritis is due to increased

numbers of epithelial, endothelial, and mesangial cells as well as

neutrophils in and around the capillary loops (arrows)

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APGN

immune deposits are distributed in the capillary loops in a

granular, bumpy pattern because of the focal nature of the

deposition process .

28

EM -immune deposits of PSGN are predominantly subepithelial,

a large subepithelial "hump" at the right of the BM (arrows).

The capillary lumen is filled with a PMN whose nuclear lobes (arrows)and

cytoplasmic granules are visibl(arrows).

29

EM-Typical electron-dense subepithelial "hump(arrow) and

intramembranous deposits. BM, basement membrane; CL, capillary lumen; E, endothelial cell; Ep, visceral epithelial cells (podocytes )

30

The IgA is deposited mainly in mesangium, which then

increases mesangial cellularity (arrow) .

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mesangial matrix enlargement is conspicuous and predominates over a

relatively mild mesangial cell proliferation.

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Mesangial proliferation can be much more intense, global

and diffuse

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IF demonstrates positivity with antibody to IgA.

the pattern is that of mesangial staining.

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small electrondense mesangial deposits are found even in

glomeruli with a normal appearance by LM.

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Mesangial involvement is variable, but often characterized by a sub-

membranous concentration of the electrondense deposits.(x 4600)

36

LM-The renal tubular cells appear foamy (arrows)because of the

accumulation of neutral fats and mucopolysaccharides. The

glomeruli show irregular thickening and splitting of basement

membranes.

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thin and attenuated BM in Alport

syndrome

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The diagrams below illustrate normal BM(LT) vs the

thickened and 'falling apart' of Alport GBM(RT)

BM

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The final

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Crescentic GN (PAS stain).

the collapsed glomerular tufts and the crescent-shaped mass of

proliferating cells and leukocytes internal to Bowman's capsule.

IF micrograph of a glomerulus CGN demonstrates

positivity with antibody to fibrinogen.

42

Chronic GN.

A MT stain shows complete replacement of virtually all

glomeruli by blue-staining collagen.

43

Acute

pyelonephritis.

The cortical surface

is studded with

focal pale

abscesses

44

Benign nephrosclerosis.

arterioles with hyaline deposition, marked thickening of the walls

and a narrowed lumen.

45

Malignant hypertension.

Fibrinoid necrosis of afferent arteriole (PAS stain).

46

Malignant hypertension

Hyperplastic arteriolosclerosis (onion-skin lesion).

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CYSTIC DISEASES OF THE

KIDNEY

Simple renal Cysts

Cystic change associated with chronic renal dialysis.

These kidneys are about normal in size but have a few scattered cysts,

none of which is over 2 cm in size. This is

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Normal term infant kidneys

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Cysts are fairly small but uniformly distributed throughout the

parenchyma so that the disease is usually symmetrical in appearance

with both kidneys markedly enlarged.

53

Hydronephrosis of the kidney,

with marked dilation of the pelvis

and calyces and thinning of renal

parenchyma.

Renal cell carcinoma:

typical cross-section of

yellowish, spherical

neoplasm in one pole of

the kidney.

Note the tumor in the

dilated, thrombosed renal

vein.

Renal cell carcinoma High-power detail of the clear cell pattern

Wilm's tumor of the kidney

Wilm's tumor nests and sheets of dark blue cells at the

left with compressed normal renal parenchyma at the right.

The tumor shows attempts to form primitive glomerular and

tubular structures

Transitional cell carcinoma of UB

Papillary Urothelial (transitional)

carcinoma-low grade

The cut surfaces of the kidney demonstrate normal cortex and medulla,

but the calyces show focal papillary tumor masses of transitional cell

carcinoma.

62

Final material

63

Crescentic GN (PAS stain).

the collapsed glomerular tufts and the crescent-shaped mass of

proliferating cells and leukocytes internal to Bowman's capsule.

IF micrograph of a glomerulus CGN demonstrates

positivity with antibody to fibrinogen.

65

Chronic GN.

A MT stain shows complete replacement of virtually all

glomeruli by blue-staining collagen.

66

Acute

pyelonephritis.

The cortical surface

is studded with

focal pale

abscesses

67

Benign nephrosclerosis.

arterioles with hyaline deposition, marked thickening of the walls

and a narrowed lumen.

68

Malignant hypertension.

Fibrinoid necrosis of afferent arteriole (PAS stain).

69

Malignant hypertension

Hyperplastic arteriolosclerosis (onion-skin lesion).

70

CYSTIC DISEASES OF THE

KIDNEY

Simple renal Cysts

Cystic change associated with chronic renal dialysis.

These kidneys are about normal in size but have a few scattered cysts,

none of which is over 2 cm in size. This is

73

Normal term infant kidneys

75

Cysts are fairly small but uniformly distributed throughout the

parenchyma so that the disease is usually symmetrical in appearance

with both kidneys markedly enlarged.

76

Hydronephrosis of the kidney,

with marked dilation of the pelvis

and calyces and thinning of renal

parenchyma.

Renal cell carcinoma:

typical cross-section of

yellowish, spherical

neoplasm in one pole of

the kidney.

Note the tumor in the

dilated, thrombosed renal

vein.

Renal cell carcinoma High-power detail of the clear cell pattern

Wilm's tumor of the kidney

Wilm's tumor nests and sheets of dark blue cells at the

left with compressed normal renal parenchyma at the right.

The tumor shows attempts to form primitive glomerular and

tubular structures

Transitional cell carcinoma of UB

Papillary Urothelial (transitional)

carcinoma-low grade

The cut surfaces of the kidney demonstrate normal cortex and medulla,

but the calyces show focal papillary tumor masses of transitional cell

carcinoma.