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บทที่ 11 Pathology of urinary system - Coggle Diagram
บทที่ 11 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
• Nephrotic syndrome
– Minimal change disease
– Membranous nephropathy
• Nephritic syndrome
– Postinfectious GN
– IgA nephropathy
Minimal change disease
• Most common cause of nephrotic syndrome in children
• Light microscopy
– Normal glomeruli
• Electron microscopy
– Effacement of epithelial (podocyte) foot processes
Membranous Nephropathy
Drugs, Tumors, SLE, Infections
• Deposition of Ag-Ab complexes: subepithelium
• Indolent, but >60% persistent proteinuria
• MC cause of nephrotic syndrome in adults
Urinary Tract Infection
• Most commonly arises clue to ascending infection
• Risk factors include sexual intercourse, urinary stasis, and catheters
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
Goodpasture syndrome
(antiglomerular basement membrane disease)
coarse granular deposits
hump-shaped deposits located subepithelially
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%)
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
Acute Pyelonephritis
• Causes:
– Ascending infection
–Hematogenous seeding Staphlococcus
and E. coli.
• Common in patients with:
ncompetent ureteral valves.
– Diabets
–Immunocomplomise
• Abscesses and papillitis
more common in diabetics.
อาการ
Flank pain, fever, dysuria, pyuria and bacteriuria
Mechanical obstruction
• Clinical manifestations include:
– Renal colic,
– Hydronephrosis,
– Infection,
In adults,the condition is most often acquired
• This obstruction may occur anywhere in the urinary system
• In children,most often congenital.
Renal Lithiasis
most common: • Calcium stones (80%–85%) :
Second most common:• Ammonium magnesium phosphate stones
• Uric acid stones
• Cystine stone
Acute Tubular Necrosis
• Acute renal failure
• 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
• NSAIDs, penicillin, and diuretics.
• Eosinophils may be seen in urine.
• May progress to renal papillary necrosis
Adult Polycystic Kidney Disease
• Clinical manifestations include:
–Hypertension
–Hematuria
– Palpable renal masses
– Progression to renal failure
• Genetic defect is present at birth
• Replacement of renal parenchyma by cysts
• Frequently associated with cystic disease of the liver
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