11. Renal Pathology D - Cox

• diabetic kidney disease - longstanding hyperglycemia will cause mesangial matrix expansion

  • thickening pattern
  • lesion due to deposition of lipohyaline
• What is the primary driver of damage in DKD?

  hyperglycemia
• DKD - hyperglycemia will cause

  • formation of glycation end production
  • activated immune destruction
  • excess ECM = increase type 4 collage + degradation by MMP
• hyperglycemia will cause podocyte damage leading to destruction of GBM

  • resulting in segmental glomerulosclerosis
• DKD - matrix expansion: nodular is called Kimmelstiel Wilson lesion
• DKA - there is tubular atrophy due to chronic interstitial inflammation leading to papillary necrosis
• DKD - There is diffuse thickening of GBM (early structural change)

  • mesangial region expanded due to increase mesangial matrix
  • hyalinosis lesion
  • foot process effacement and podocyte loss
• DKA clinical

  • persistent microalbuminuria 30 - 300
  • progress to macroalbuminuria > 300 mg/d
  • leading to end stage renal disease
  • elevated arterial BP
• amyloidosis - insoluble protein - beta pleated sheets - deposited in organs
• Amyloidosis deposits in

  • glomeruli
  • tubulointerstitium
  • tubules (amyloid casts) vessel walls
• amyloidosis will make the kidney larger due to deposition and mass effect
• systemic lupus erythematosus associated immune complex mediated renal injury

  • activate classical complement pathway leading to inflammation
• Lupus - Full House: IgG, IgA, IgM, C3, C1q positive
• Lupus: tubuloreticular inclusion - use for establishing diagnosis

  • reticular aggregates in endothelial cells
• What can you find in RPGN?

  glomerular crescents
• RPGN pathology to crescents

  • endothelial injury
  • rupture of GBM
  • trigger coagulation cascade within bowman's space
  • fibrin deposition
  • stimulation of parietal epithelial cell proliferation
• RPGN - crescent will lead to collapse glomerular tuft and tubular outflow obstruction
• RPGN - flea beaten appearance due to petechial hemorrhage
• RPGN - rapid renal dysfunction

  • will have Acute nephritic syndrome