Document about the 'mechanisms of kidney damage' section, given by pathologist Dr Koshy aan de Kul, 1st GNK master.
This document includes the slides and info from Prof Dr Kuypers' book.
Supplementary to the nephrology summary.
Pathology: mechanisms of kidney injury
General structure of kidney parenchyma
Kidney = brown, red in color
- Highly vascularized
- 25% van CO output
Normal size: 10 X 6,5 X 3 cm (10-11 cm)
Function of kidney:
- Plasma filtration → concentrated urine (1L urine per day)
- Excretion of waste products
- Regulation blood flow
- Endocrine organ
- Metabolism of VitD
Nephrons and blood vessels
Nephron= structural and functional unit of the kidney, consists of the glomerulus + entire loop
- Bowman capsule: where filtration occurs
- Renal artery with glomerulus:
o Direct branch of abdominal aorta
o Enters kidney at the hilum → branches into segmental arteries → interlobar arteries
→ arterioles
o Afferent arteriole: enters glomerulus (capillaries) → efferent, forms peritubular
capillaries around all the tubules → renal veins → VCI
- Tubules: absorb the nutrients and secretes the toxins → urine
→ 1 million nephrons per kidney
2 types
Biopsy in clinic: cortex (medulla: only loop of Henle and collecting duct → majority is glomerular
related)
1. Cortical nephrons: superficial in upper part of cortex
2. Juxtamedullary nephrons: mid cortical region
→ related to certain diseases
Functions
Overvieuw on slide→ pathology = defects, mechanism of disease
→ ultrafiltration is mean function
Renal corpuscle
= bowman capsule and glomerulus (capillaries)
All blood vessels: lined by endothelial cells (inner lining)
- Specialized: fenestrated → filtration
Outer lining: epithelial cells
- Specialized: podocytes
- Holds on to capillary wall
- Responsible for maintaining structure of capillary lumen + have slit like spaces → filtration
Parietal epithelial cells: lines the Bowman’s space
- At tubular pole → become columnar, forms brush border → becomes proximal tubule cells
, Mesangium (connective tissue) connects the cells above
- Destroys foreign bodies of immune complexes
- Phagocytic action
Two pole ends: 1: vascular pole (where arterioles enters)
- Juxtaglomerular region: macula densa, juxtamedullary cells
o High profile filtration function
2: Tubular pole: proximal tubule
Chronic kidney disease
can be silent (prerenal – renal -postrenal) → late diagnosed
Global burden:
- Extremely common in the last 15 years
- Because of better diagnostic ways → more recognition of disease
- High mortality → important to diagnose early
RF:
- Elderly with comorbidities (diabetes, is a pandemic)
- Women
- Auto-immune diseases (lupus most common)
EU burden:
- 1/3 is at risk
- Mostly asymptomatic
1. Handling of kidney biopsy
Indications for renal biopsy
A. Unexplained acute of rapidly progressive renal failure
Certain parameters → see other lessons (decides grade of progression)
B. Nephrotic syndrome and non-nephrotic proteinuria
C. Persistent glomerular hematuria
D. Systemic diseases
E. Renal allograft dysfunction (tx)
Most common: auto-immune diseases
Handling
2 cores, 1-2 cm → we need mostly cortex, glomerular corpuscles (most
diseases: glomerular related)
Identify cortex or medulla under microscope
- Red points: not fixed tissue, blood gets stuck in glomeruli
Divide tissue: 1 glomerulus for fluorescence, one for EM, rest for
microscopy
Fixatives:
- Light microscopy: formaldehyde, maintains the architecture of the tissue
- Immunofluorescence: specialized microscopy, for identifying immunocomplex deficits → no
fixator: fresh frozen tissue
- EM: ultrastructural components of kidney, glutaraldehyde
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