Departemen Patologi Anatomi

Universitas Islam Sumatera Utara

2009
 Parts of juxtamedullary nephron
General organization of the
kidney (collecting duct & tubule)
Normal Adult Kidney (Cross Section)

This demonstrates:
Cortex (lighter
outer)
Medulla (the darker)

Renal pyramids into

which the collecting
ducts coalesce

Drain into :
calyces &
central pelvis.
 Renal Corpuscle

Upper part shows

vascular pole:
Afferent
Efferent
Macula dense
Flattened cells (parietal
cells of Bowmans
capsule)
Lower part shows :
Urinary pole
Proximal convoluted
tubule
 Normal Glomerular
Mesangial cells

Endothelial cells Epithelial cells

Mesangial cell located between capillaries
enveloped by the basement membrane
 Renal cortex
(Pararosaniline-toluidine blue stain)

Birds eye (view of the renal cortex), composed :

Proximal (P)
Distal (D) Convoluted tubules
Renal glomeruli (G)
Normal glomerulus (Microscopic)

The glomerular
capillary loops are
thin and delicate.
Endothelial &
mesangial cells
are normal in
number.
The surrounding
tubules are
normal.
 Glomerular Diseases
Clinical Manifestations of Glomerular Disease
Asymptomatic proteinuria
Nephrotic syndrome
(proteinuria, hypoproteinemia, lyperlipidemia, edema)
Asymptomatic hematuria
Glomerulonephritis
(hematuria, proteinuria, hypertension, renal failure)
Acute glomerulonephritis
(neprhitis with short term renal failure)
Crescentic glomerulonephritis
(nephritis with rapidly progressive renal failure)
Chronic glomerulonephritis
(chronic progression of renal failure)
End Stage Renal Disease
(irreversible renal failure)
 Pathways of
renal infection
Membranous Glomerulonephritis

The capillary loops are

thickened & prominent
But cellularity isnt
Most common cause for
nephrotic syndrome
(adults)
Some linked to a
chronic infectious
disease such as:
hepatitis B
carcinoma, or
SLE
Idiopathic (many
cases)
Chronic Glomerulonephritis

Atrophic kidneys
from autopsy with chronic
renal failure (CRF)
Cortex (thin)
1/3 to 1/2 of patients with CRF :
slowly reach end stage
significant signs or symptoms
along the way (-)
End stage renal disease (ESRD) :
Diagnostic features (-)
Point in performing a renal
biopsy(-)
Serum creatinine & urea nitrogen
are clues.
Most patients will also be
hypertensive.
Some simple cysts are also seen
here
Acute Pyelonephritis

An ascending bacterial
infection leading to acute
pyelonephritis.
Numerous PMN's are
seen filling renal tubules
across the center and
right of this picture
 Chronic Pyelonephritis

The large collection of chronic inflammatory cells here is

in a patient with a history of multiple recurrent urinary
tract infections.