Difference between revisions of "Medical kidney diseases"

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Medical kidney diseases (view source)

Revision as of 18:48, 11 May 2011

88 bytes added ,  18:48, 11 May 2011
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Kidney tumours are dealt with in the ''[[kidney tumours]]'' article.
Kidney tumours are dealt with in the ''[[kidney tumours]]'' article.


==Clinical==
=Clinical=
===Glomerular filtration rate===
===Glomerular filtration rate===
*Abbreviated ''GFR''.
*Abbreviated ''GFR''.
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*Features of nephritic syndrome and nephrotic syndrome.
*Features of nephritic syndrome and nephrotic syndrome.


==Normal==
=Normal=
===Epithelium<ref name=Ref_PBoD956>{{Ref PBoD|956}}</ref>===
===Epithelium<ref name=Ref_PBoD956>{{Ref PBoD|956}}</ref>===
*The glomeruli visceral epithelium is part of the capillary wall (part of the glomerular tuft).   
*The glomeruli visceral epithelium is part of the capillary wall (part of the glomerular tuft).   
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Diseases with crescents - is a long list.<ref>URL: [http://path.upmc.edu/cases/case51/dx.html http://path.upmc.edu/cases/case51/dx.html]. Accessed on: 9 November 2010.</ref>
Diseases with crescents - is a long list.<ref>URL: [http://path.upmc.edu/cases/case51/dx.html http://path.upmc.edu/cases/case51/dx.html]. Accessed on: 9 November 2010.</ref>


==Pathologic DDx==
=Pathologic DDx=
The clinical presentations suggest a pathologic DDx.<ref>URL: [http://www.emedicine.com/med/topic886.htm http://www.emedicine.com/med/topic886.htm] and [http://www.emedicine.com/ped/topic1564.htm http://www.emedicine.com/ped/topic1564.htm]. Accessed on: 8 November 2010.</ref>
The clinical presentations suggest a pathologic DDx.<ref>URL: [http://www.emedicine.com/med/topic886.htm http://www.emedicine.com/med/topic886.htm] and [http://www.emedicine.com/ped/topic1564.htm http://www.emedicine.com/ped/topic1564.htm]. Accessed on: 8 November 2010.</ref>


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In children nephrotic syndrome is assumed to be ''minimal change disease''.  Biopsies are done only there is no response to steriods.
In children nephrotic syndrome is assumed to be ''minimal change disease''.  Biopsies are done only there is no response to steriods.


=Diseases=
==Diabetes mellitus==
==Diabetes mellitus==
===General===
===General===
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*Hypertensive kidneys have changes only in the afferent arteriole, i.e. the efferent arteriole is spared (see ''[[hypertension]]'').
*Hypertensive kidneys have changes only in the afferent arteriole, i.e. the efferent arteriole is spared (see ''[[hypertension]]'').


==IgA nephropathy==
==Lupus nephritis==
===General===
===General===
*[[AKA]] Berger disease.
*Abbreviated ''LN''.
*More common in Asians.
*Bread & butter of nephropathology.


===Microscopic===
===Immunofluorescence===
Features:
*"Full house" = call of 'em light up.
*Mesangial hypercellularity - may be only light microscopy finding.
*Diagnosis based on immunofluorescence (IgA+).


Image: [http://library.med.utah.edu/WebPath/jpeg2/RENAL096.jpg IgA nephropathy (med.utah.edu)].
===Classification===
International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification:<ref>{{cite journal |author=Weening JJ, D'Agati VD, Schwartz MM, ''et al.'' |title=The classification of glomerulonephritis in systemic lupus erythematosus revisited |journal=J. Am. Soc. Nephrol. |volume=15 |issue=2 |pages=241–50 |year=2004 |month=February |pmid=14747370 |doi= |url=http://www.nature.com/ki/journal/v55/n2/full/4490631a.html}}</ref><ref>URL: [http://www.med.niigata-u.ac.jp/npa/Lectures/Lupus_Nephritis.htm http://www.med.niigata-u.ac.jp/npa/Lectures/Lupus_Nephritis.htm]. Accessed on: 9 November 2010.</ref>
*Class I - minimal mesangial LN.
*Class II - mesangial proliferative LN.
*Class III - focal lupus nephritis; <50% of glomeruli.
*Class VI - diffuse segmental or global LN; >50% of glomeruli.
*Class V - Membranous lupus nephritis.
*Class IV - Advanced sclerosing LN; essentially end-stage kidney.


====Scoring====
Notes:
IgA nephropathy can be scored using an assessment of '''m'''esangial proliferation, '''e'''ndocapillary proliferation, glomerulo'''s'''clerosis and '''t'''ubular atrophy and interstitial fibrosis (abbreviated ''MEST'').<ref>{{Cite journal | last1 = Coppo | first1 = R. | last2 = Cattran | first2 = D. | last3 = Roberts Ian | first3 = SD. | last4 = Troyanov | first4 = S. | last5 = Camilla | first5 = R. | last6 = Cook | first6 = T. | last7 = Feehally | first7 = J. | title = The new Oxford Clinico-Pathological Classification of IgA nephropathy. | journal = Prilozi | volume = 31 | issue = 1 | pages = 241-8 | month = Jul | year = 2010 | doi =  | PMID = 20693944 }}</ref>
*Most of the action is in Class III and Class IV.   
 
**Class I is near normal - doesn't get biopsied.
==Rapidly progressive glomerulonephritis==
**Class IV is essentially dead kidney - doesn't get biopsied.
*Abbreviated ''RPGN''.
===General===
*Acute renal dysfunction.
 
DDx:
*Post-infectious GN.
*Pauci-immune GN.
 
===Microscopic===
Features:
*Crescents.
*+/-Neutrophils (suggestive of post-infectious GN).
 
Image:
*[http://commons.wikimedia.org/wiki/File:Crescentic_glomerulonephritis_%282%29.jpg RPGN (WC)].
*[http://commons.wikimedia.org/wiki/File:Crescentic_glomerulonephritis_%281%29.jpg RPGN (WC)].
 
==Membranous nephropathy==
===General===
*[[AKA]] ''membranous glomerulonephritis''.
*Presents as nephrotic syndrome.
 
Clinical DDx:<ref>{{Ref Klatt|241}}</ref>
*Hepatitis B.
*Hepatitis C.
*Carcinoma.
*NSAID toxicity.
*SLE.
*Idiopathic.
 
===Microscopic===
Features:
*Subepithelial immune complex depositions, spike forming.
 
Image:
*[http://commons.wikimedia.org/wiki/File:Membranous_Nephropathy_Pathology_Diagram.svg MN - schematic (WC)].


=Nephrotic syndrome=
==Focal segmental glomerulosclerosis==
==Focal segmental glomerulosclerosis==
===General===
===General===
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Features:<ref>URL: [http://www.kidneypathology.com/English_version/Focal_segmental_GS.html http://www.kidneypathology.com/English_version/Focal_segmental_GS.html]. Accessed on: 11 February 2011.</ref>
Features:<ref>URL: [http://www.kidneypathology.com/English_version/Focal_segmental_GS.html http://www.kidneypathology.com/English_version/Focal_segmental_GS.html]. Accessed on: 11 February 2011.</ref>
*PAS +ve crescents.
*PAS +ve crescents.
==Membranous nephropathy==
===General===
*[[AKA]] ''membranous glomerulonephritis''.
*Presents as nephrotic syndrome.
Clinical DDx:<ref>{{Ref Klatt|241}}</ref>
*Hepatitis B.
*Hepatitis C.
*Carcinoma.
*NSAID toxicity.
*SLE.
*Idiopathic.
===Microscopic===
Features:
*Subepithelial immune complex depositions, spike forming.
Image:
*[http://commons.wikimedia.org/wiki/File:Membranous_Nephropathy_Pathology_Diagram.svg MN - schematic (WC)].
=Mixed nephrotic and nephritic==
==IgA nephropathy==
===General===
*[[AKA]] Berger disease.
*More common in Asians.
===Microscopic===
Features:
*Mesangial hypercellularity - may be only light microscopy finding.
*Diagnosis based on immunofluorescence (IgA+).
Image: [http://library.med.utah.edu/WebPath/jpeg2/RENAL096.jpg IgA nephropathy (med.utah.edu)].
====Scoring====
IgA nephropathy can be scored using an assessment of '''m'''esangial proliferation, '''e'''ndocapillary proliferation, glomerulo'''s'''clerosis and '''t'''ubular atrophy and interstitial fibrosis (abbreviated ''MEST'').<ref>{{Cite journal  | last1 = Coppo | first1 = R. | last2 = Cattran | first2 = D. | last3 = Roberts Ian | first3 = SD. | last4 = Troyanov | first4 = S. | last5 = Camilla | first5 = R. | last6 = Cook | first6 = T. | last7 = Feehally | first7 = J. | title = The new Oxford Clinico-Pathological Classification of IgA nephropathy. | journal = Prilozi | volume = 31 | issue = 1 | pages = 241-8 | month = Jul | year = 2010 | doi =  | PMID = 20693944 }}</ref>


==Membranoproliferative glomerulonephritis==
==Membranoproliferative glomerulonephritis==
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*Mesangial hypercellularity.
*Mesangial hypercellularity.


==Lupus nephritis==
=Nephritic syndrome=
==Rapidly progressive glomerulonephritis==
*Abbreviated ''RPGN''.
===General===
===General===
*Abbreviated ''LN''.
*Acute renal dysfunction.
*Bread & butter of nephropathology.


===Immunofluorescence===
DDx:
*"Full house" = call of 'em light up.
*Post-infectious GN.
*Pauci-immune GN.


===Classification===
===Microscopic===
International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification:<ref>{{cite journal |author=Weening JJ, D'Agati VD, Schwartz MM, ''et al.'' |title=The classification of glomerulonephritis in systemic lupus erythematosus revisited |journal=J. Am. Soc. Nephrol. |volume=15 |issue=2 |pages=241–50 |year=2004 |month=February |pmid=14747370 |doi= |url=http://www.nature.com/ki/journal/v55/n2/full/4490631a.html}}</ref><ref>URL: [http://www.med.niigata-u.ac.jp/npa/Lectures/Lupus_Nephritis.htm http://www.med.niigata-u.ac.jp/npa/Lectures/Lupus_Nephritis.htm]. Accessed on: 9 November 2010.</ref>
Features:
*Class I - minimal mesangial LN.
*Crescents.
*Class II - mesangial proliferative LN.
*+/-Neutrophils (suggestive of post-infectious GN).
*Class III - focal lupus nephritis; <50% of glomeruli.
*Class VI - diffuse segmental or global LN; >50% of glomeruli.
*Class V - Membranous lupus nephritis.
*Class IV - Advanced sclerosing LN; essentially end-stage kidney.


Notes:
Image:
*Most of the action is in Class III and Class IV.
*[http://commons.wikimedia.org/wiki/File:Crescentic_glomerulonephritis_%282%29.jpg RPGN (WC)].  
**Class I is near normal - doesn't get biopsied.
*[http://commons.wikimedia.org/wiki/File:Crescentic_glomerulonephritis_%281%29.jpg RPGN (WC)].
**Class IV is essentially dead kidney - doesn't get biopsied.


=Rare diseases=
==Fabry disease==
==Fabry disease==
===General===
===General===
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*Cystic [[renal cell carcinoma]].
*Cystic [[renal cell carcinoma]].


==Transplant==
=Transplant=
===General===
===General===
Rejection can be:
Rejection can be:
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*Hyaline arteriopathy with a peripheral and nodular distribution (chronic toxicity).
*Hyaline arteriopathy with a peripheral and nodular distribution (chronic toxicity).


==See also==
=See also=
*[[Kidney tumours]].
*[[Kidney tumours]].
*[[Urinary bladder]].
*[[Urinary bladder]].
*[[Genitourinary pathology]].
*[[Genitourinary pathology]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


==External links==
=External links=
*[http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/rnfrm.html Nephropathology quiz (med.utah.edu)].
*[http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/rnfrm.html Nephropathology quiz (med.utah.edu)].
*[http://www.fondazionedamico.org/biopsiarenale_atlas/seco/crio/crio.htm Cryoglobulinemic nephritis (fondazionedamico.org)].
*[http://www.fondazionedamico.org/biopsiarenale_atlas/seco/crio/crio.htm Cryoglobulinemic nephritis (fondazionedamico.org)].


[[Category: Genitourinary pathology]]
[[Category: Genitourinary pathology]]
Michael
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