professor peivand pirouzi: pathophysiology of the urinary system 2016
TRANSCRIPT
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Pathology of the Urinary System
Professor Peivand Pirouzi, Ph.D., M.B.A., C.C.P.E.School of Health Sciences Seneca College of Applied Arts and TechnologyToronto, Canada
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Normal Urinary Tract
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Normal Nephron
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Overview of Major Kidney Diseases
• Immunologic disorders (e.g., glomerulonephritis)
• Metabolic disorders (e.g., diabetic nephropathy)
• Circulatory disturbances (e.g., prerenal renal failure)
• Bacterial infections (e.g., pyelonephritis – urinary tract infection)
• Tumors
• Urinary Tract Infection movie 4’
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Developmental Disorders
• Renal agenesis: bilateral or unilateral
• Horseshoe kidney (renal fusion or super kidney)
• Polycystic kidney disease (inherited, progressive failure)
• Multicystic renal dysplasia (unilateral, dysfunctional kidneys)
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Autosomal Polycystic Kidney Disease
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Glomerulopathies
DIS- -Disseminated intravascular coagulation
GN: Glomerulonephritis
SLE: systemic lupus erythematosus
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Glomerular Diseases
• Immunologic diseases: glomerulonephritis
•Metabolic diseases: diabetes, amyloidosis*
•Circulatory disturbances: hypertension, atherosclerosis, disseminated intravascular coagulation (DIS)
* buildup of misfolded proteins known as amyloids
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Immune-Mediated GlomerularDiseases: Clinical Presentation
• Acute renal failure (RPGN): crescentic glomerulonephritis (GN)
• Nephritic syndrome: acute GN, systemic lupus erythematosus (SLE)
• Nephrotic syndrome: lipoid nephrosis, membranous nephropathy*, focal segmental glomerulosclerosis**
• Isolated hematuria/proteinuria: Berger’s (IgA) disease, SLE
• Chronic renal failure: chronic GN
*deposition of immune complexes on the glomerular basement membrane
(GBM) with GBM thickening
**scar tissue in the filtering unit of the kidney
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Nephritic Syndrome: Clinical Features
• Hematuria
• Red blood cell (RBC) casts, dysmorphic/fragmented RBCs in urinary sediment
• Oliguria (the production of abnormally small amounts of
urine.)
• Proteinuria
• Hypoalbuminemia
• Edema, generalized
• Hypertension
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Normal Glomerulus byElectron Microscopy (EM)
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Poststreptococcal AcuteGlomerulonephritis by Electron Microscopy
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Acute Glomerulonephritis: Microscopy
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Crescentic Glomerulonephritis
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Membranous Nephropathy: Light Microscopy
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Membranous Nephropathy: Immunofluorescence Microscopy
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Membranous Nephropathy: Electron Microscopy
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Nephrotic Syndrome: Electron Microscopy
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End-Stage Glomerulopathy: Macroscopic Features
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End-Stage Glomerulopathy: Microscopic Features
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Diabetic Glomerulosclerosis
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Urinary Stones
• Calcium stones: calcium phosphate or calcium oxalate stones (75%)
• Struvite stones (15%)
• Uric acid stones (5%)
• Cystine stones (1%)
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Struvite Stone
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Urinary Infections
• Pyelonephritis: invasion of kidney
• Acute
• Chronic
Symptoms: Fever, Chills, high WBC
• Cystitis: superficial infection
• Acute
• Chronic
Symptoms: Dysurea (Difficult or painful urination) , urgency
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Routes of Renal Infection
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Chronic Pyelonephritis
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Acute Cystitis
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Chronic Cystitis
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Circulatory Disturbances
• Acute tubular necrosis*
• Nephroangiosclerosis
• Hypertension
• ATN: death of tubular epithelial cells that form the renal tubules of
the kidneys
• ** associated with hypertension; sclerosis of the renalarterioles redu
ces blood flow that can lead to kidney failure and heart failure
• *** also called renovascular hypertension, is elevated blood
pressure caused by kidney disease. It can usually be controlled by
blood pressure drugs.
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Neoplasms of Urinary Tract
• More often malignant than benign
• Wilms’ tumor: only neoplasm found in children; all others occur in older adults
• Originate from epithelial cells of kidney or urothelium (transitional cell lining of pelvis, ureter, urinary bladder, posterior urethra)
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Urinary Tract Tumors• Most important:
• Wilms’ tumor
• Transitional cell carcinoma
• Renal cell carcinoma:
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Urinary Tract Tumors (Cont’d)
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Renal Cell Carcinoma
• Common: 27,000 new cases; 11,000 cancer-related deaths per year in U.S.
• No strong risk factors identified
• Found in 5% of chronic end-stage kidney disease patients
• Occurs in older adults (>50 years)
• Prognosis guarded: 50% survive 5 years
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Renal Cell Carcinoma: Macroscopic Features
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Renal Cell Carcinoma: Microscopic Features
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Renal Cell Carcinoma: Clinical Features
• Hematuria: most common finding (50%)
• Typical triad (hematuria, flank pain, palpable abdominal mass) found only in 10%
• Nonspecific symptoms common, often found accidentally (“internist’s tumor”)
• Paraneoplastic syndromes: hypercalcemia, erythrocytosis, or amyloidosis (20%)
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Wilms’ Tumor
• Tumor of infancy, childhood
• Composed of immature cells resembling renal blastemal (mass of undifferentiated cells)
• Related, in some cases, to deletion or mutation of tumor suppressor gene WT1
• May be familial or bilateral in 10% cases
• Good prognosis: surgery + chemotherapy
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Carcinoma of Urinary Bladder
• Most common cancer of urinary tract: 52,000 new cases per year in the U.S.; 10,000 cancer-related deaths
• Most tumors are transitional carcinomas, but may be squamous or adenocarcinomas
• Variable prognosis: depends on grade/stage of tumor
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Urinary Bladder Carcinoma
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Urinary Bladder Carcinoma: Microscopic Features
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Urinary Bladder Carcinoma:Clinical Features
• Hematuria
• Dysuria
• Lower abdominal pain
• Diagnosis made on urine cytology and cystoscopic biopsy
• Grade I tumors localized to mucosa: 98% 5-year survival, but tend to recur
• Grade III tumors with metastases: 15% 5-year survival
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Bladder Cancer