Renal System Pathology Overview

Renal System Pathology 1

• The presentation covered renal system pathology, presented by Dr. Iman A. Zainel.
• The presenter is a Fellow of the College of Medicine in Surgery (F.I.C.M.S.) and two other fellowships.
• Normal kidney anatomy and histology were examined.
• Diagrams and images of the nephron, Bowman's capsule, glomerulus, and other key components were included.
• A detailed examination of the normal glomerulus, including the GBM, endothelial cells, podocytes, and mesangial cells, was shown with micrographs.
• The presentation also included an introduction that categorized kidney diseases by the primary affected component, including glomerular, tubular, interstitial, and vascular.
• This division is helpful due to distinctive early manifestations and varying pathogeneses.
• Toxic or infectious agents lead to frequent tubular and interstitial disorders. While glomerular diseases are often immunologically mediated.
• All forms of chronic renal disease ultimately damage all four components leading to chronic renal failure or end-stage kidney disease.
• Nephrotic syndrome, characterized by proteinuria of at least 3.5g/day (in adults), hypoalbuminemia (<3g/dL), generalized edema, and hyperlipidemia, was part of the lecture. Symptoms like tachycardia, vomiting, pale skin, and fissures, were detailed.
• Nephritic syndrome presents with hematuria (blood in the urine), red blood cell casts, proteinuria (usually sub-nephrotic range) and or possibly edema, azotemia (high blood levels of nitrogenous waste), and hypertension.
• Different types of cystic kidney diseases were discussed, including polycystic kidney disease (autosomal dominant and recessive types).
• Cystic renal dysplasia and acquired (dialysis-associated) cystic disease were also covered.
• Renal cysts can appear in hereditary syndromes (such as tuberous sclerosis).
• Other types include glomerulocystic and parasitic cysts (like hydatid cysts), were outlined.
• Autosomal dominant polycystic kidney disease (ADPKD) was characterized as multiple cyst development in both kidneys leading to renal failure.
• The prevalence is 1 in every 400 to 1000 live births, contributing 5-10% of chronic renal failure instances needing dialysis or transplantation.
• The inheritance pattern is autosomal dominant with high penetrance, and cysts are typically bilateral. The disease progressively affects nephrons, and renal function is retained until the 4th or 5th decade of life. The genetic mutation is on chromosomes 16 (PKD1) and 4(PKD2) .
• Pathogenesis, localization of immune complexes, and non-immune mechanisms of glomerular disease were detailed.
• The presentation detailed the different histological changes of the glomerular diseases, including diffuse, focal, global, segmental, and mesangial changes.
• Immune-mediated mechanisms (in situ immune complex deposition, circulating immune complex deposition, and cytotoxic Ab), along with non-immune mechanisms (adaptive changes secondary to renal ablation) were presented. This includes focal segmental glomerulosclerosis and tubulo-interstitial fibrosis.
• Several types of glomerular diseases were listed, such as primary glomerulonephritis (acute diffuse proliferative, rapidly progressive, membranous, lipoid, focal segmental glomerulosclerosis, and membranoproliferative GN IgA, and chronic glomerulonephritis) and secondary glomerular diseases (infections, SLE, malignant tumors, drugs, hereditary disorders (Alport's, Fabry's).
• Minimal change disease (lipoid nephrosis) was presented as the most frequent cause of nephrotic syndrome in children, typically between the ages of 2 and 6, related to immune dysfunction.
• Membranous glomerulonephropathy (MGN) in adults as a common nephrotic syndrome cause was discussed, associated with immune complex deposition related to renal GBM autoantigen.
• Additional causes of MGN, such as drugs, malignant tumors, SLE, infections and autoimmune diseases were noted
• Classification, morphology, and pathogenesis of renal diseases, like acute postinfectious post-streptococcal glomerulonephritis, and IgA nephropathy were presented.
• Clinical course, prognosis, and different types of presentation were presented for various renal diseases

This quiz covers the key aspects of renal system pathology, focusing on normal kidney anatomy, histology, and the various types of kidney diseases. Presented by Dr. Iman A. Zainel, it categorizes kidney diseases based on the primary affected components and discusses the distinctive features and pathogeneses of these conditions, including glomerular, tubular, interstitial, and vascular disorders.