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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= | |||
===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= | |||
===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= | |||
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]]''). | ||
== | ==Lupus nephritis== | ||
===General=== | ===General=== | ||
* | *Abbreviated ''LN''. | ||
* | *Bread & butter of nephropathology. | ||
=== | ===Immunofluorescence=== | ||
*"Full house" = call of 'em light up. | |||
* | |||
===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. | |||
Notes: | |||
*Most of the action is in Class III and Class IV. | |||
**Class I is near normal - doesn't get biopsied. | |||
**Class IV is essentially dead kidney - doesn't get biopsied. | |||
* | |||
* | |||
* | |||
* | |||
=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. | ||
== | =Nephritic syndrome= | ||
==Rapidly progressive glomerulonephritis== | |||
*Abbreviated ''RPGN''. | |||
===General=== | ===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)]. | ||
=Rare diseases= | |||
==Fabry disease== | ==Fabry disease== | ||
===General=== | ===General=== | ||
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*Cystic [[renal cell carcinoma]]. | *Cystic [[renal cell carcinoma]]. | ||
=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= | |||
*[[Kidney tumours]]. | *[[Kidney tumours]]. | ||
*[[Urinary bladder]]. | *[[Urinary bladder]]. | ||
*[[Genitourinary pathology]]. | *[[Genitourinary pathology]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
=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]] |
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