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**บทที่ 11(2) Pathology of urinary system - Coggle Diagram
**บทที่ 11(2) Pathology of urinary system
Functions of the kidney:
Excretion of waste products
Regulation of water/salt
Maintenance of acid/base balance
Secretion of hormones
Diseases of the kidney
Glomeruli
Tubules
Interstitium
Vessels
Nephrotic syndrome
• Massive proteinuria
• Hypoalbuminemia
• Generalized edema
• Hyperlipidemia/-uria
Nephritic syndrome
• Hematuria
• Oliguria
• Azotemia
• Hypertension
RENAL FAILURE
• Acute or chronic
• glomerular or tubulointerstitial lesions
• In advanced stages, renal failure results in uremia
clinical syndrome
symptomatic renal disease
Glomerular disease
• Nephrotic syndrome
– Minimal change disease
– Membranous nephropathy
• Nephritic syndrome
– Postinfectious GN
– IgA nephropathy
Minimal change disease
• Most common cause of nephrotic syndrome in children :red_flag:
• Light microscopy
– Normal glomeruli :red_flag:
• Electron microscopy
– Effacement of epithelial (podocyte) foot processes
Membranous Nephropathy
สาเหตุ
• Drugs, Tumors, SLE, Infections
• Deposition of Ag-Ab complexes: subepithelium
• Indolent, but >60% persistent proteinuria
• MC cause of nephrotic syndrome in adults
Acute Diffuse Proliferative Glomerulonephritis
• This produces the nephritic syndrome in children
group A, beta -hemolytic streptococci.
fix complement and attract PMN's.
There is swelling and proliferation of glomerular endothelial cells.
hypercellular and bloodless :red_flag:
coarse granular deposits
hump-shaped deposits located subepithelially
Goodpasture syndrome
(antiglomerular basement membrane disease)
• Antiglomerular basement membrane antibodies directed against antigens in glomerular and pulmonary alveolar
• Clinical manifestations include:
– Peak incidence in men in their mid-20s
Urinary Tract Infection
• Most commonly arises clue to ascending infection
• Risk factors include sexual intercourse, urinary stasis, and catheters
Acute Cystitis
• Infection of the bladder
• Presents as dysuria, urinary frequency, urgency, and suprapubic pain
UrinalysisͶcloudy urine with > 10 WBCs/high power field (hpf)
• Etiology
– E.coli (80%) :red_flag:
Acute Pyelonephritis
• Causes:
– Ascending infection
–Hematogenous seeding
Staphlococcus
and E. coli.
• Common in patients with:
– Incompetent ureteral valves.
– Diabets
–Immunocomplomise
• Abscesses and papillitis
more common in diabetics.
อาการ
Flank pain, fever, dysuria, pyuria and bacteriuria
Mechanical obstruction
• This obstruction may occur anywhere in the urinary system.
• In children,most often congenital.
• In adults,the condition is most often acquired,
• Clinical manifestations include:
– Renal colic,
– Hydronephrosis,
– Infection,
Renal Lithiasis
most common: • Calcium stones (80%–85%) : :red_flag:
Second most common:• Ammonium magnesium phosphate stones :red_flag:
• Uric acid stones
• Cystine stones
Acute Tubular Necrosis
• Acute renal failure :red_flag:
• Classification:
– Ischemic:shock, sepsis
– Toxic: drugs,
• Pathology: variable, focal to extensive
• Pathogenesis:– vasoconstriction,obstruction, tubular leakage of filtrate.
• Distal convoluted tubules and collecting ducts contain hyaline casts.
• Clinical features
Oliguria with brown,Elevated BUN and creatinine
Drug-Induced Interstitial Nephritis
• Acute renal failure :red_flag:
• NSAIDs, penicillin, and diuretics.
• Eosinophils may be seen in urine. :red_flag:
• May progress to renal papillary necrosis
Adult Polycystic Kidney Disease
• Genetic defect is present at birth :red_flag:
• Replacement of renal parenchyma by cysts
• Frequently associated with cystic disease of the liver
• Clinical manifestations include:
–Hypertension
–Hematuria
– Palpable renal masses
– Progression to renal failure
Childhood Polycystic Kidney Disease
• Autosomal recessive inheritance
cysts in the cortex and medulla
• Cysts also occur in the liver;association with congenital hepatic fibrosis leading to portal hypertension
Multicystic renal dysplasia
• Usually unilateral; when bilateral, must be distinguished
Renal Cell Carcinoma
• 85% of renal cancers in adults.
• VHL gene
• Spherical, yellow-gray-white mass with necrosis and hemorrhage.
• Invasion of renal vein is common.
• Clear cell variant (70-80%):
– round to polygonal cells with clear to granular cytoplasm.
• Classic triad: hematuria, costovertebral pain, palpable mass
Wilm's tumor
Macro
• Large solitary well-circumscribed mass,
• Soft, homogenous,tan-to-gray cut surface
• +/- necrosis, cyst,hemorrhage
Micro; contains 3 components
Stromal component : spindle-shape cells
Epithelial component : immature tubules immature glomeruli
Blastemal component : primitive small blue cells
Urinary Bladder tumors; common in
Increase incidence of bladder tumor
M:F=3:1
Most are sporadic (not familial) :red_flag:
Risk factors (bladder tumors)
Cigarette smoking (increase threefold to sevenfold) :red_flag:
(70% are squamous cell CA)
Urinary bladder CA
Epithelial origins (95%)
Transitional cell (Urothelial) CA (90%)
Gross
Papillary lesion
Clinical course
Painless hematuria* dominant
Frequency, urgency & dysuria
Early detection ; Urine cytologic study :red_flag:
Prostate
Inflammation
• Acute bacterial prostatitis
Escherichia
เกิดที่ posterior urethra
• Chronic bacterial prostatitis
Asymptomatic or low back pain, dysuria, and perineal and suprapubic discomfort
Benign enlargement
• Benign prostatic hyperplasia (BPH)
Most commonly affects the inner periurethral zone Æ
producing nodules that compress the prostatic urethra
Clinical Features
Urinary obstruction
Urinary frequency, nocturia,difficulty in starting and stopping the stream of urine,
Medical therapy:alpha blockers, inhibitors of 5-ɲ-reductase
Surgical therapy Transurethral resection of the prostate (TURP)
Tumor
• Adenocarcinoma
Range from indolent lesions
Definitive risks factors
Age
Family history
Race/geography
Probable risk factors
Diet
Hormone
Clinical Features
Most asymptomatic
serum prostate-specific antigen (PSA) levels
Laboratory
Serum PSA
