pathology of the urinary system (kidney, urinary tract, bladder)
TRANSCRIPT
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Pathology
of the
Urinary System
(Kidney, Urinary Tract, Bladder)
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Plan:
Lecture 1: Recap of anatomy and physiology, clinical aspects of renal disease, pathogenesis of glomerulonephritis
Lecture 2:Morphologic expressions of glomerular injury, primary glomerular diseases
Lecture 3:Primary glomerular disease
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Introduction.
• Weight 150 g
• Cortex (1.5 cm) and
medulla
• Renal pelvis - 2 to 3
major calyces - each
3-4 minor calyces.
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Filters about 1700 L of blood
to prepare 1 L of urine
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Anatomical structure of parenchyma ..
Lobe
Lobule
Cortex
Medulla
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Anatomical structure of parenchyma .
Lobules
Cortex
o Columns of
Bertin
Medulla (O , I)
o Pyramid
o Papilla
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The Cortex
Labyrinth
Medullary rays
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Vasculature
Renal artery
- anterior and posterior br ---- interlobar ---- arcuate ---
interlobular ---- afferent arteriole ---- glomerulus ---- efferent
arteriole ---- peritubular capillaries ---- vasa recta ---- venous
vasa recta ---- renal vein
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Vascular structure of parenchyma
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Renal vasculature
• Arteries are end arteries• Glomerular diseases can compromise
vascular supply to other components• Medulla is relatively avascular and
vulnerable to ischemia• Cortex is more vulnerable to hypertensive
changes
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The Nephron
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(Pathology) Compartments
• Glomeruli
• Tubules
• Interstitium
• Blood vessels
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Glomerulus
• Formation• Components• Structure
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Glomerulus
• Formation• Components• Structure
• Bowmans capsule• Parietal epithelial cells• Visceral epithelial cells• Basement membrane• Endothelial cells• Mesangial cells• Mesangial matrix
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Glomerulus
• Formation• Components• Structure
Bowmans capsuleParietal epithelial cellsVisceral epithelial cellsBasement membraneEndothelial cellsMesangial cellsMesangial matrix
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Glomerulus
• Formation• Components• Structure
Filtration membrane
• fenestrated endothelial cells (70-100
nm);
• glomerular Basement Membrane
• visceral epithelial cells -podocytes
(20-30 nm)
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Glomerulus
• Formation• Components• Structure
• Glomerular basement membrane: - Thick inner lamina densa - Lamina rara externa and interna.
Collagen IV, laminin, polyanionic proteoglycans, intermediate filaments, other glycoproteins.
Filtration is governed by size and charge.
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The Glomerulus
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The Glomerulus
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Basement Membrane: (LM)
Identified better using special
stains such as
PAS (Per-iodic acid Schiff)
Silver impregation methods
Invests capillaries incompletely,
and is continuous with capsular
BM
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Juxta-glomerular apparatus
• JG cells of afferent arteriole,
• macula densa of DCT,
• Lacis cells of mesangium
Principal source of renin
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Tubules and interstitium
• Proximal tubules: Rich in mitochondria, microvilli, canaliculi
and interdigitations - Major site for re-absorption of water,
glucose, sodium, potassium, phosphate, proteins, amino acids.
Vulnerable to vascular and toxic injury.
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.
.
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Histology of PCT
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Proximal tubules:
Abundant granular cytoplasm
Distal tubules:
Cuboidal cells
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Loops of
Henle,
and
Collecting
Ducts
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Interstitium:
Scanty in the cortex and outer medulla
More abundant in inner medulla