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Module HOMEOSTASIS AND EXCRETION

6.4. Pathology of the Urine Excretion Organs


Contents:
Categories of the pathologoanatomical diagnoses. Nosological and pathogenetic
principles of diagnosis formulation.
Clinical syndromes if kidney damage. Damage of glomerule, its pathogenesis,
structural changes, mechanisms of progression, classification and clinical carsus.
Pyelonephritis, its pathogenesis and morphology. Urolithiasis.
Polycystic kidney disease.
Morphology of the chronic renal failure (uremia).
Tasks:
1. Analyse morphological changes of the glomeruli damage, paying attention
to it illustrating preparations, discuss on pathogenesis of these changes and possible
complications.
2. Study pathogenesis, morphology and complications of pyelonephritis and
illustrate it by preparations.
3. Discuss on mechanisms of development and possible complications of the
simple cysts and polycystic kidney disease.
4. Discuss why kidney diseases can cause systemic arterial hypertension?
5. Choose macropreparations with kidney damage, possible induce kidney
failure (uremia).
6. Solve (in written) morphological diagnostic tasks: establish main disease,
its morphological backgraund, mark compensatory processes, indicate complications
and possible causes of death.
7. Find out, draw and mark typical pathological changes in the histological slides
and electron micrographs, relate them with macroscopical ones.
Macropreparations
Glomerulonephritis chronica
Hypertrophia ventriculi sinistri cordis
Haemorrhagia cerebri
Bronchopneumonia
Urolithiasis: calculus pelvis renalis, pyelonephritis chronica
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Pericarditis fibrinosa (uraemica)


Enterocolitis fibrinoso-necroticans uraemica
Pyelonephritis acuta abscedens
Reactio immunica lienis
Glomerulonephritis haemorrhagica
Cystis renum
Polycystosis renum
Electron micrograph
24. Glomerulonephritis endocapillaris diffusa proliferativa (x8500).
Capillary lumen is narrowed because of proliferating endotheliocytes, large deposits
(immune complexes) in basal membrane.

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31. Glomerulonephritis, minimal changes (seu minimal change disease)


(x30 000). Pay attention to the changes of glomerular filter: swelled endothelium
with pinocytic vacuoles, unequaly swelled basal membrane, effaced small foot
processes. Comparise these changes with normal structure of glomerular filter.

Histological slides
48/48a. Glomerulonephritis diffusa extracapillare proliferativa (H+E). Find
inflammatory exudate and cells proliferation (crescents) in Bowman capsule
cavity; proteinous casts and erythrocytes in the lumen of tubules, cytoplasmatic
proteinosis in epithelium of convoluted tubules (if it present).

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Discuss and mark, which in 48 preparation noticed changes maintain


proteinuria, which hematuria.
What additional investigations supposed to perform after establishing of these
histological changes in kidney biopsy material?

49. Pyelonephritis chronica (H+E). Notice focal infiltration of immune cells


(lymphocytes, macrophages, plasma cells, granulocytes) in the interstitial tissue,
granulocytes in the lumen of tubules and small scars with atrophied tubules. Pay
attention to dilated, with atrophical epithelium tubules, which lumenis filled with
proteineous casts, and sclerosated glomeruli and arterias, arterioles. To what indicate
these changes of blood vessels?

Self-learning questions
Remember the histology and physiology of kidney (glomerular filter).
What clinical syndromes of kidney damage do you know and what is characteristic
for them?
What are mostly frequent morphological changes of glomeruli and its results?
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What are deposits?


What are the main pathogenetic mechanisms of the glomeruli damage and mechanisms of progression?
What kidney structure changes are characteristic for acute endocapillary proliferative
(poststreptococcal, postinfectious) glomerulonephritis, what is pathogenesis of these
changes?
What kidney structure changes are characteristic for rapidly progressing (crescentic)
glomerulonephritis, what is pathogenesis of these changes?
Remember pathogenesis, morphology and clinical course of the membranous nephropathy, minimal - change disease, focal segmental glomerulosclerosis and
membranoproliferative (mesangiocapillary) glomerulonefritis.
What is relation between glomerulonepritis and systemic arterial hypertension?
What is pyelonephritis?
What are the main pathogeneticvariants of pyelonephritis?
How are classified pyelonephrites?
What are mostly frequent causative factors of pyelonephrites?
What is morphology of pyelonephrites?
What are possible complications and causes of death in cases of the pyelonephrites?
What is difference of the conceptions - uremia and urosepsis?
By which laboratory tests may be established kidney failure (uremic) syndrome and
what are its causes and morphology?
What is urolithiasis?
What are mostly frequent components and mechanisms of formation of the urinary
calculi (stones)?
What are possible complications and causes of death in cases of urolithiasis?
Why develop cycts in kidneys?
What is polycystosis of the kidney, what is its morphology and complications?
What is the immune response?
What is inflammation?
What are main causative factors of the inflammation?
What are the main cells participating in inflammation?
What is the main defensive mechanism of inflammation?
What are the phases of inflammation?
What is exudate and from what depends its composition?
What is difference between exudate and transudate?
Which cells indicate chronic course of the inflammation?
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Solving of the Diagnostic Morphological Task


Diagnostic task is composed up by some macropreparations, 12 histological
slides or microphotographs, 12 electron micrographs set.
The task is solved in three steps.
The first step: during analysis of preparations, it is necessary to identify the
organ, tissue or cell and their adaptive-compensatory or pathological processes
which are going on.
The second step: to make diagnosis according to the nosological and
pathogenetic principles and categories of processes (main disease, complications
etc.).
The third step: in the practical notebook write down the diagnosis in Latin,
according to the presented form and defend at the discussion.
Self learning questions
What is a disease?
Explain conception of disease (nosological unit) and syndrome
What are components (categories) of the pathologoanatomic diagnosis? Discuss
them.
How to understand nosological and pathogenetic principles of diagnosis
formulation?
What is iatrogenic pathology?
How do you understand etiological, predisposing and risk factors of disease?
References
1. Kumar V., Abbas A.K., Aster J. Robbins Basic Pathology, with STUDENT
CONSULT Online Access, 9th Edition, Elselvier Science 2013.
2. Atlas of Histopathological Slides for Problem-Based Learning (http://
www.pathonet.lt/atlasas_en/a2ks63.htm)
3. Virtual microscopy for practical works (http://www.pathonet.lt/moodle/course/
view.php?id=34).

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MORPHOLOGICAL DIAGNOSTIC TASK


I. Define the organ, tissue, ultrastructure and make a diagnosis of pathological
or adaptive compensatory processes:
1. ...........................................................................................................................................
2. ...........................................................................................................................................
3. ...........................................................................................................................................
4. ...........................................................................................................................................
5. ...........................................................................................................................................
6. ...........................................................................................................................................
II. Diagnosis of the main disease:
....................................................................................................................................................
....................................................................................................................................................
III. According to the investigated preparations point out:
1. Morphological background of the main disease
....................................................................................................................................................
....................................................................................................................................................
2. Compensatory adaptive processes
....................................................................................................................................................
....................................................................................................................................................
3. Complications of the main (or iatrogenic) disease
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
..........................................................................................................................................
4. Direct cause of death
....................................................................................................................................................

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Program
1. Damage of the glomeruli, its pathogenesis, structural changes, mechanisms of
progression and clinical syndromes.
2. Pathogenesis, morphology and clinical course of the hematuria/nephritic
syndrome causing (most frequently) by acute proliferative (poststreptococcal,
postinfectious) glomerulonephritis.
3. Pathogenesis, morphology and clinical course of the rapidly progressive
(crescentic) glomerulonephritis.
4. Pathogenesis, morphology and clinical course of the proteinuria/nephrotic
syndrome causing (most frequently) by membranous nephropathy, minimal-change
disease, focal segmental glomerulosclerosis and membranoproliferative
(mesangiocapillary) glomerulonephritis (causing mixed symptoms syndrome).
5. Morphology and clinical course of chronic glomerulonephritis.
6. Pyelonephritis, its pathogenesis, classification, morphology, complications and
causes of death.
7. Urolithiasis, its pathogenesis, morphology, complications and causes of death.
8. Kidney cysts and polycystic kidney disease, its pathogenesis, morphology and
complications.
9. Morphological manifestations of the kidney failure (uremic syndrome).

Selflearning time 16:0017:30, 203 room


Appeal to administrator for studies

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