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Kidney Lect 5

General Pathology Review and Introduction to Renal Pathology

cellular swelling and hydropic changes indicate... reversible injury
coagulation of cytoplasmic protein indicate... irreversible injury
What do necrotic cells generally look like? Necrotic cells are eosinophilic due to increased binding of eosin (dye) to denatured proteins, a phenomenon known as eosinophilia. The cytoplasm is glassy, homogeneous and vacuolated (moth-eaten). Focal calcification is also seen.
Coagulative necrosis result of denaturing of the cellular proteins. Basic outline of the coagulated cells is morphologically preserved.
Liquefactive necrosis seen in bacterial and fungal infections with accumulation of inflammatory cells, ending in complete digestion of the dead cells and the development of a liquid viscous mass (Pus)
Caseous necrosis white, “cheesy” and amorphous. The necrotic tissue is seen as amorphous granular debris as in cases of mycobacterial infection or TB.
It is an essential reaction of the body to defend itself against harmful agents, including bacterial infections. It destroys injurious agents, dilutes injurious agents and walls of the process, triggering healing and reconstruction of the damaged tissue Inflammation
Acute inflammation Acute inflammation is short lived in minutes to a few days, and the hallmark cell is the neutrophil or granulocyte
Chronic inflammation chronic inflammation is usually of longer duration and the hallmark cells are mostly mononuclear lymphocytes, plasma cells, macrophages and sometimes eosinophils.
IgE immune mediated reactions and parasitic infections are characterized by the presence of... eosinophils
When do you see granulomas? What do you see inside of them? Granulomas are seen when activated macrophages and giant cells are present to engulf specific types of bacteria like in tuberculosis, leprosy, and syphilis or foreign bodies as seen in foreign body granulomas.
What (3) ways can tissue repair themselves after injury? 1) regeneration of native parenchyma (e.g. liver) 2) filling the defect with fibroblastic tissues or scar (e.g. heart/muscles). 3) (Most commonly), a combination of both processes occurs, resulting in some recovery of functions (e.g. kidneys)
Angenesis Congenital anomaly: total absence of the kidneys
Hypoplasia kidneys are small and ill formed at birth
ectopic kidney kidneys are found in the wrong place at birth
horshoe kidney two kidneys do not separate during development at the lower poles in a horseshoe manner
Cystic renal dysplasia presenting at a young age (pediatrics) and manifesting as numerous small cysts in the kidneys
polycystic kidney disease can either be autosomal dominant and presents in young adults, or autosomal recessive presenting during childhood
medullary cystic disease cysts are mostly affecting the distal tubules in the medulla.
Localized renal cysts simple cysts, and can vary in size from very small to very large cysts. They are very commonly seen as incidental findings at resection or autopsy. They are mostly asymptomatic.
How is tissue obtained from a biopsy divided? 1) Largest part fixed in Bouin’s fixative for 2 hours-->light microscopic examination 2. Small portion immediately frozen in OCT-->stained and studied under Immunofluorescence microscopy 3. Smallest portion fixed in 2% glutaraldehyde solution-->EM
How is renal biopsy material prepared for light microscopy examination? The largest part is fixed in Bouin’s fixative for 2 hours, washed, processed and cut at 3-4 microns for light microscopic examination.
How is renal biopsy material prepared for immunofluorescence microscopy examination? A small portion is immediately frozen in OCT and cut at 5 micron thickness to be stained for immunoglobulins and studied under immunofluorescence microscopy
How is renal biopsy material prepared for EM? The smallest portion is cubed at 1 mm and fixed in 2% glutaraldehyde solution, embedded in hard resin, cut and examined under the electron microscope
What stain is used for: basic morphology? Basement membrane morphology (thickness, splitting, spikes)? hematoxylin and eosin (H&E) for basic morphology, methamine Silver stain (black) for basement membrane morphology, including thickness, splitting and spikes.
hematoxylin and eosin (H&E) for basic morphology
methamine Silver stain (black) for basement membrane morphology, including thickness, splitting and spikes
Periodic Acid Schiff stain (PAS, fuscia red) also for basement membranes, deposits and glycogen
Trichrome Stain (blue or green in a red background) to disclose the amount of fibrosis and hence chronicity of the renal damage.
Congo-red (pink with apple-green birefringence under polarized light), is used in suspected amyloidosis
How do you assess glomeruli under light microscopy? Assessed for the number of cells present either within the mesangial areas, endothelial, and intraglomerular vs extraglomerular. Extracellular matrix may show changes, including sclerosis, increased mesangial substance, fibrosis, amyloidosis…etc.
What do tubules look like in acute tubular necrosis? tubules may be necrotic (look for RED DEAD nuclei, diffuse pink stain in H&E)
What do tubules look like in artheriosclerosis? Degenerative; dilated as a compensation mechanism for lost adjacent tubules
How do you assess the interstitum under light microscopy? What does it look like in: tubular atrophy? pyelonephritis? Chronic renal failure? Normally it is barely seen between the tubules, but may expand in cases of tubular atrophy, may show edema or inflammatory infiltrate in cases of pyelonephritis, or fibrosis in long standing chronic renal failure.
What features do you asses in renal blood vessels? Cellular changes in intima, media, and adventitia (for larger arteries) and thickness, duplication of elastic lamina, inflammatory infiltrate, or other abnodmal findins in smaller vessels
What differences do you in the immunofluorescence microscopy assesment of tissue with: anti GBM? lupus? immunoglobulin deposits are linear; dedeposits are granular;
What can an EM study show you? Abnormalities in the glomerular capillaries (should be patent and basement membranes thin and intact; epithelial cells should show intact, sharp foot processes). Can also show abnormalities in mesengial cell thickness+number and prescence of immune cells
Portion of the glomerulus vs. the entire glomerulus shows pathologic changes Segmental vs. global
All vs. some but not all glomeruli are affected with any process Diffuse vs. Focal
Sclerosis fibrosis
Hyalinosis degeneration
necrosis cell death
Created by: karkis77



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