Renal pathology II Acute tubular necrosis From Stevens

Renal pathology II

Acute tubular necrosis From: Stevens A. J Lowe J. Pathology. Mosby 1995 Fig. 20. 1. Macroscopically, kidneys are enlarged, pale, friable (appearance of boiled meat); on the cut section, the renal cortex is pale and medulla is congested.

From cases of the Pathology Department - U. M. F. “Gr. T. Popa” Iasi Fig. 20. 2. In toxic acute tubulonecrosis, the lesions are located in proximal epithelial tubules and consist in tubular epithelial necrosis: (a) necrotic epithelial cells have uniform eosinophilic appearance, and lose the nuclei; some of them detache and fall in the lumen (epithelial cylinders or casts); (b) tubular BM is intact, forming the support for remaining regenerating epithelial cells; (c) normal glomeruli.

Acute pielonephritis From: Stevens A. J Lowe J. Pathology. Mosby 1995 Fig. 20. 3. Kidney is swelled and congested and presents disseminated small abscesses on the renal surfaces. These abscesses appear as yellow nodules, of 2 mm in diameter, under tension, surrounded by an hyperaemic area.

From cases of the Pathology Department - U. M. F. “Gr. T. Popa” Iasi Fig. 20. 4. Acute pielonephritis. MO: (a) interstitial microabscesses containing occasionally microbial colonies; (b) renal tubules contain leucocitary casts or cylinders, which are highlighted in urinary test; (c) glomeruli are normal.

Tuberculous pyelonephritis From: Stevens A. J Lowe J. Pathology. Mosby 1995 Fig. 20. 5. Macroscopically, are described twoo forms: (a) nodular type: multiple cazeous nodules of 0, 5 -2 cm in diameter; (b) ulcerative type: destructive renal parenchyma through caseous material removed by urine. Microscopically, there are large areas of caseous necrosis surrounded by lymphocytes, and fibroblasts.

Renal clear cell carcinoma or renal adenocarcinoma (Grawitz T) From: Stevens A. J Lowe J. Pathology. Mosby 1995 Fig. 20. 6. It is the most common malignant kidney tumor in adults. It appears as a polar tumoral mass with false encapsulation, proiemining from the kidney cortex. The tumor has a yellow-gray appearance (lipid cell content) with areas of necrosis and hemorrhages.

Renal clear cell carcinoma or renal adenocarcinoma (Grawitz T) From cases of the Pathology Department - U. M. F. “Gr. T. Popa” Iasi Fig. 20. 7

Fig. 20. 7 -8 It is a pseudoencapsulated tumor with origin in tubular epithelium. The tumor has two components: (a) tumoral parenchymal cells (polyedrical cells with central, hypercromatic nuclei and clear cytoplasm containing glycogen and lipid deposits) arranged as cords, sheats, or tubules. (b) stroma is reduced but with a rich vascular network.

Nephroblastoma (Wilms Tumor) From: Stevens A. J Lowe J. Pathology. Mosby 1995 Fig. 20. 9. It is a white-gray, lobular appearance, sarcomatous-like tumor.

From cases of the Pathology Department - U. M. F. “Gr. T. Popa” Iasi Fig. 20. 10. It is the most common malignant renal tumor in children. It develops from renal blastema and its stromal and epithelial derivatives. The tumor has three microscopical componentes: (a) undifferentiated blastema (small, round, hypercromatic cells); (b) mesenchymal component (spindle cells with sarcomatous appearance); (c) epithelial component (glomerular and tubular structures of embryonary or abortive type).

Urothelial transitional carcinoma From: Stevens A. J Lowe J. Pathology. Mosby 1995 Fig. 20. 11.

Papillary transitional carcinoma Fig. 20. 12. Origin: urothelial mucosal epithelium (transitional); • Macroscopy: small vegetative tumor (2 cm), pediculated, looking villous; • Microscopy: connective-vascular axis thinned, branched, covered by transitional epithelium with normal histology and cytology