PathomorPathomorphologyphology ofof kidney kidney diseasesdiseases

As.-proff. V.Voloshyn

According:prof. Bodnar Ya.Ya.; prof. Sorokina I.V.; Frank Netter

Main aim of lectureMain aim of lecture

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To find out reasons and To find out reasons and mechanisms of development of mechanisms of development of nephropathy.nephropathy.

To expose – macro- and To expose – macro- and microscopic displays of nephropathymicroscopic displays of nephropathy..

To define the basic clinic-To define the basic clinic-morphological displays of chronic morphological displays of chronic kidney insufficiencykidney insufficiency. .

ActualityActuality

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Illnesses of kidneys Illnesses of kidneys is group of is group of illnesses which are the numeral and varied illnesses which are the numeral and varied as in clinical so morphological displays and as in clinical so morphological displays and takes fifth line in morbidity of population takes fifth line in morbidity of population after the traumatism, heart & vessels after the traumatism, heart & vessels diseases, tumors and pulmonary pathologies.diseases, tumors and pulmonary pathologies.

Up to now the classification, diagnostics Up to now the classification, diagnostics and treatments methods of nephropathy and treatments methods of nephropathy provocate the hot discussions between provocate the hot discussions between specialists of different type which diagnose specialists of different type which diagnose and treat these illnessesand treat these illnesses

History of studies about History of studies about pathomorphology of nephropathypathomorphology of nephropathy

At the beginning of XVII century R. At the beginning of XVII century R. Brite offered the first classification of Brite offered the first classification of nephropathy nephropathy

At the beginning of XX century At the beginning of XX century clinicist Folgart and pathologist Far clinicist Folgart and pathologist Far divided Brite’s illness on three divided Brite’s illness on three groups:groups: - nephrites;- nephrites; - nephroses;- nephroses; - nephroscleroses.- nephroscleroses.

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Classification of nephropathyClassification of nephropathy

Structural-functional principle lies in the basis Structural-functional principle lies in the basis of modern clinic-morphologic classification of of modern clinic-morphologic classification of nephropathynephropathy ..

SELECT SUCH GROUPS OF NEPHROPATHY:SELECT SUCH GROUPS OF NEPHROPATHY:glomerulopathy;glomerulopathy;tubulopathy;tubulopathy;tubulostromal nephropathy;tubulostromal nephropathy;pyelonephritis;pyelonephritis;nephrosclerosisnephrosclerosisanomalies of development;anomalies of development;tumours.tumours.

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Clinical syndromes at Clinical syndromes at nephropathynephropathy

Urinary – is the recidive unpain Urinary – is the recidive unpain hematuria, oliguria, proteinuria, hematuria, oliguria, proteinuria, leucocyturia, cylindruria;leucocyturia, cylindruria;

Heart & vessels – is increase of Heart & vessels – is increase of arteriotony (especially diastolic), arteriotony (especially diastolic), hypertrophy of the left ventricle of hypertrophy of the left ventricle of heart;heart;

Nephrotic – is lipidemia, heavy Nephrotic – is lipidemia, heavy proteinuria, warm white edemata of proteinuria, warm white edemata of lower limbs.lower limbs.

Anaemic – toxic influence on marrow Anaemic – toxic influence on marrow (firm (стійка) anaemia)(firm (стійка) anaemia)

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The seat of pathomorphology The seat of pathomorphology in diagnostics of nephropathyin diagnostics of nephropathy

Introduction in practical work of Introduction in practical work of nephrologists:nephrologists:

- - transskin kidney biopsy;transskin kidney biopsy; - electronic microscopy;- electronic microscopy; - іmmunomorphology- іmmunomorphology

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The norm structure of glomerulusThe norm structure of glomerulus

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GlomerulopathyGlomerulopathy

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Group of kidneys glomerules diseases Group of kidneys glomerules diseases which has congenital, which has congenital, primery-purchased primery-purchased and secondary-purchased and secondary-purchased origin. Their origin. Their pathogeny consists in formation of pathogeny consists in formation of immune complexes with their fixing on immune complexes with their fixing on the basale membranes of glomerulis, or the basale membranes of glomerulis, or (in the case of autoimmune mechanism) (in the case of autoimmune mechanism) formation of autoantibodies to the basale formation of autoantibodies to the basale membrane.membrane.

Main types of damage of glomerulusMain types of damage of glomerulus

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Classification of Classification of glomerulopathyglomerulopathy

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Congenital Congenital glomerulopathyglomerulopathy :: Syndrome of AlpoportSyndrome of Alpoport Congenital nephrotic syndromeCongenital nephrotic syndrome Inherited (спадковий) lardaceous? Inherited (спадковий) lardaceous?

(amyloidosis) of kidneys(amyloidosis) of kidneys Initially-purchased Initially-purchased glomerulopathyglomerulopathy:: glomerulonephrytis with the minimum glomerulonephrytis with the minimum

changing.changing. Postinfectial (poststreptococcic).Postinfectial (poststreptococcic). Subacute (semilunar).Subacute (semilunar). Syndrome of Goodpascher.Syndrome of Goodpascher. Chronic glomerulonephrytisChronic glomerulonephrytis

CongenitalCongenital glomerulopathyglomerulopathy

The syndrome of Alpoport is The syndrome of Alpoport is combination of lipoid tubulo- combination of lipoid tubulo- and interstitial nephropathy and interstitial nephropathy and glomerulopathy with the and glomerulopathy with the lowering of hearing and lowering of hearing and vision.vision.The inherited nephrotic The inherited nephrotic syndrome is combination of syndrome is combination of minimum changing of minimum changing of podocytes, intracapillar podocytes, intracapillar productive productive glomerulonephrytis with glomerulonephrytis with polycystosispolycystosisPeriodic illness – is Periodic illness – is combination of widespread combination of widespread lardaceous with polyserositislardaceous with polyserositis

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Main types of damage of glomerulusMain types of damage of glomerulus

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GlomerulonephrytisGlomerulonephrytis with with the minimum changingthe minimum changing

is characterized by is characterized by practically complete practically complete absence of changes absence of changes in preparation which in preparation which are investigated by are investigated by light microscope.light microscope.An electronic An electronic

microscopy displays microscopy displays out the changing of out the changing of small appendices of small appendices of podocytespodocytes

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Postinfection (poststreptococcy) Postinfection (poststreptococcy) glomerulonephrytisglomerulonephrytis

The most frequent reason The most frequent reason is В-hemolytic is В-hemolytic

streptococcus of A group.streptococcus of A group.Glomerulis are Glomerulis are megascopic, amemic, megascopic, amemic, polymorphonuclear polymorphonuclear leucocytes are present in leucocytes are present in an interstitium. an interstitium. An electronic microscopy An electronic microscopy displays out displays out subephithelial deposits, subephithelial deposits, proliferation and swelling proliferation and swelling of endotheliocytesof endotheliocytes

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Subacute Subacute (quick progressic, malignant, (quick progressic, malignant, semilunar semilunar glomerulonephrytis)glomerulonephrytis)

““Large white kidney”,Large white kidney”,

””large pied (строкатa) large pied (строкатa) kidney”kidney”

””large red kidney”.large red kidney”.

There are “crescent” There are “crescent” (“halfmoons”)(“halfmoons”)

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Syndrome of GoodpascherSyndrome of Goodpascher Quick progressicQuick progressic

glomerulonephrytisglomerulonephrytis which which is combined with is combined with hemorrhagic-fibrinic hemorrhagic-fibrinic pneumonia, and also with pneumonia, and also with iron-deficient anemia.iron-deficient anemia.

Specific antibodies against Specific antibodies against the glicoprotein antigens of the glicoprotein antigens of uncollogen portion of uncollogen portion of collogen IV are determined in collogen IV are determined in a whey (сироватka)a whey (сироватka)

In kidneys IgG and C3 are In kidneys IgG and C3 are determined at determined at immunofluorescence; At light immunofluorescence; At light microscopic – are microscopic – are “halfmoons”.“halfmoons”. 17

Chronic Chronic glomerulonephrytisglomerulonephrytis The independent disease is with the The independent disease is with the

primary damage of glomerulis and primary damage of glomerulis and secondary the pathological process secondary the pathological process extends into tubulis and stromaextends into tubulis and stroma

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Morphological forms of Morphological forms of chronic chronic glomerulonephrytisglomerulonephrytis

MesangioproliferativicMesangioproliferativic MembranousMembranous Membranous-proliferativic or Membranous-proliferativic or

Mesangiocapillaric.Mesangiocapillaric. IgA is nephropathy (illness of Berje)IgA is nephropathy (illness of Berje)

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Mesangioproliferativic chronic Mesangioproliferativic chronic glomerulonephrytisglomerulonephrytis

Pathogeny is Pathogeny is unknownunknownProliferation of Proliferation of

mesangiocytes is mesangiocytes is aspecificaspecificFocal and segmental Focal and segmental

proliferation are proliferation are simultaneoussimultaneousThe increasing of The increasing of

mesangial matrice At mesangial matrice At shick-reactionshick-reaction

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Membranous chronic Membranous chronic glomerulonephrytisglomerulonephrytis

EtiologyEtiologyThere is a idiopathic illness in 85 % of all There is a idiopathic illness in 85 % of all patients. patients. Reasons of secondary membranous chronic Reasons of secondary membranous chronic glomerulonephritisglomerulonephritis are are: :

infections (syphilis, malaria, hepatitis B);infections (syphilis, malaria, hepatitis B); medicinal and chemical matters (penicillin, gold, medicinal and chemical matters (penicillin, gold,

mercury, heroin);mercury, heroin); tumors (lymphadenomas, bronchogenic tumors);tumors (lymphadenomas, bronchogenic tumors); sickle-cellsickle-cell anemia; anemia; system lupus erythematosus.system lupus erythematosus.

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Membranous chronic Membranous chronic glomerulonephrytisglomerulonephrytis

1 stage - the 1 stage - the subephithelial laying of subephithelial laying of depositsdeposits2 stages - the 2 stages - the membranous and membranous and subephithelial laying of subephithelial laying of depositsdeposits3 stages - the 3 stages - the intramembranous and intramembranous and mesangial laying of mesangial laying of depositsdeposits4 stages - the diffuse 4 stages - the diffuse laying of deposits with laying of deposits with deformation of glomerular deformation of glomerular barrierbarrier

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Mesangioproliferative chronic Mesangioproliferative chronic glomerulonephrytisglomerulonephrytis

mesangial laying of mesangial laying of deposits; deposits; Ig G and C3 Ig G and C3 accumulates in accumulates in mesangium more mesangium more frequently.frequently.focal proliferation of focal proliferation of mesangiocytesmesangiocytes it is observed at it is observed at primary IgA-primary IgA-nephropathynephropathy

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IgA-nephropathy (illness of Berje)IgA-nephropathy (illness of Berje)

most widespread reason of chronic most widespread reason of chronic kidney insufficiencykidney insufficiencyIgA is revealed in a wheyIgA is revealed in a wheymesangial laying of depositsmesangial laying of depositsIgA accumulates in mesangiumIgA accumulates in mesangium proliferation of mesangiocytesproliferation of mesangiocytes

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Secondary acquisition Secondary acquisition glomerulonephrytesglomerulonephrytes

Diabetic nephropathyDiabetic nephropathy Amyloidosis of kidneysAmyloidosis of kidneys GlomerulonephrytisGlomerulonephrytis at system lupus at system lupus

erytematosiserytematosis

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Secondary acquisition glomerulopathySecondary acquisition glomerulopathy(Diabetic nephropathy)(Diabetic nephropathy)

Thickening of Thickening of capillaries wallscapillaries wallsEnlargement of Enlargement of volume of mesangiumvolume of mesangium

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Knot glome-Knot glome-rulosclerosis rulosclerosis (changing of (changing of Kimmelsteel-Kimmelsteel-Willson)Willson)

Secondary acquisition glomerulopathySecondary acquisition glomerulopathy(Amyloidosis of kidneys)(Amyloidosis of kidneys)

Greasy kidneyGreasy kidneyAccumulation of АА-Accumulation of АА-amyloid in amyloid in mesangium, basale mesangium, basale membranes of membranes of vessels and tubulisvessels and tubulisPositive reaction on Positive reaction on an amyloidan amyloidPhasicness of Phasicness of motion: latent, motion: latent, proteinuric, nephrotic, proteinuric, nephrotic, nitrogenemicnitrogenemic

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Secondary acquisition glomerulopathySecondary acquisition glomerulopathy(System lupus erytematosus)(System lupus erytematosus)

Laying of deposits Laying of deposits in subepithelial and in subepithelial and subendothelial layerssubendothelial layers““ecraseurs”ecraseurs”formation of formation of hematoxylin bodieshematoxylin bodies

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Secondary acquisition glomerulopathySecondary acquisition glomerulopathy(hemolytic-uremic syndrome)(hemolytic-uremic syndrome)

Subendothelial Subendothelial laying of depositslaying of depositsThickening of Thickening of capillaries wallscapillaries wallsThrombosesThrombosesInfarcts of kidney Infarcts of kidney cortexcortex

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TubulopathyTubulopathy

Purchased and inherited defeats of Purchased and inherited defeats of epithelium of nephron’s tubules, that is epithelium of nephron’s tubules, that is

accompanied by violations of their accompanied by violations of their concentric, reabsorb and secretory concentric, reabsorb and secretory

function.function. Inherited tubulopathy - is Inherited tubulopathy - is predefined by predefined by

the various forms of fermentopathies.the various forms of fermentopathies.

Purchased tubulopathy are:Purchased tubulopathy are: (acute kidney insufficiency, (acute kidney insufficiency,

myelome of kidney, gouty kidney)myelome of kidney, gouty kidney)

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Acute kidney insufficiencyAcute kidney insufficiencyNecrosis of tubules is the Necrosis of tubules is the

morphological substratum of morphological substratum of acute kidney insufficiencyacute kidney insufficiencyDistinguish ischemic (shock) and Distinguish ischemic (shock) and toxic acute kidney insufficiency.toxic acute kidney insufficiency.Reasons of toxic acute kidney Reasons of toxic acute kidney insufficiency are the action:insufficiency are the action:---heavy metals (lead, mercury, ---heavy metals (lead, mercury,

bismuth, arsenic) of gold and bismuth, arsenic) of gold and uranium;uranium;---organic solvents (chloroform, ---organic solvents (chloroform,

three-plus-onechlorous carbon); three-plus-onechlorous carbon); ---glycols (ethylen- and propilen----glycols (ethylen- and propilen-

glycols);glycols);---sulfanilamides, antibiotics ---sulfanilamides, antibiotics

(methacyclines, polimexinum); (methacyclines, polimexinum); asteroid antiinflammation asteroid antiinflammation preparations; mercury diureticspreparations; mercury diuretics

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Tubuli-interstitial nephriteTubuli-interstitial nephrite

Analgesic (analgin, Analgesic (analgin, aspirin in aspirin in connection with a connection with a phenacetin):phenacetin):HypokaliumemialHypokaliumemialUratic (gouty)Uratic (gouty)Hypercalciumemial Hypercalciumemial (metastatic (metastatic calciphylaxis);calciphylaxis);RadiationRadiation

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PyelonephritisPyelonephritisSuccessive heterospecific bacterial Successive heterospecific bacterial

ascending or descending inflammation ascending or descending inflammation of parenchima of kidney with of parenchima of kidney with predominant localization of predominant localization of pathological process in intermediate pathological process in intermediate tissue.tissue.

Risk factors : short and wide urethra at Risk factors : short and wide urethra at women, stasis of urine of diverse women, stasis of urine of diverse etiology,urinary bladde-ureter reflux, age etiology,urinary bladde-ureter reflux, age and hormonal status of patientand hormonal status of patient

Women are ill mainly (1:5).Women are ill mainly (1:5).

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PyelonephritisPyelonephritis

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Pathomorphology of chronic Pathomorphology of chronic kidney insufficiencykidney insufficiency

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Organ, tissue Morphological changes

Skin Grey-earthy color as a result of accumulation of urochrome. Uremic powder. Point hemorrhages

Mucuses membrane

Catarrhal, fibrinic or fibrinic-hemorragic gastritis, enteritis, colitis, laryngitis, tracheitis

Lungs Swelling, serosal, fibrinic or fibrinic-hemorragic niduses pneumonia

Serosal membrane

serosal- fibrinic or fibrinic pericarditis, pleuritis, peritonitis

Cerebrum Swelling, hemorrhages, hearths of softening

Heart Warty endocarditis, toxic myocarditis

Thank you for

attention!

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