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Review Urinary Histology and

Pathology Outline
Kroonpong Iampenkhae, MD
Department of Pathology
Chulalongkorn University
Renal artery
Interlobar artery
Arcuate artery
Interlobular artery
Nitrogen (Cr)

Interlobar artery
Arcuate artery
Interlobular artery
Afferent arteriole

RBC
Protein
Glucose
Normal glomerulus
PAS stain
Normal glomerulus silver stain
basement membrane
and the mesangial
matrix are silver
positive (black)

mesangium
Normal glomerulus
Trichrome stain
Macula densa

JG cells
Transmission electron microscopy of normal rat glomerulus

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 8 February 2005 03:26 PM)
2005 Elsevier
Filtration slit

Normal glomerulus
The Details
Mesangial cell
with lipid droplets
podoyte

RBC

foot process

parietal
Basement membrane
visceral epithelial
cell/podocyte

Bowmans
space
Bowmans capsule
basement membrane

Parietal epithelial
cells
Terminology to describe morphological
lesions
Focal: involving some glomeruli < 50%
Diffuse: Involving all glomeruli
Segmental: involving part of glomerular tuft
Global: involving total glomerular tuft
Nodular: acellular area of mesangial matrix expansion
(circular shape)
Glomerular sclerosis: obliteration of capillary loops
and increased matrix
Crescent: proliferation of parietal epithelial cells
admixed with inflammatory cells
Spikes: projections of glomerular basement
membrane intervening between subepithelial immune
deposits
Terminology to describe morphological
lesions
Endocapillary proliferation: proliferation of
mesangial and/or endothelial cells and infiltrating of
inflammatory cells, filling up in capillary lumens
Hyaline: smooth-appearing material (pink)
Hyalinosis: hyaline insudation of plasma protein
Subepithelium: between podocyte and glomerular
basement membrane
Subendothelium: between endothelial cells and
glomerular basement membrane
Tram-track: double contour of glomerular basement
membrane due to deposit
Wire loop: thick, rigid appearance of capillary loops
due to massive subendothelial deposits = lupus nephritis class IV
Terminology for
Immunofluorescence
Granular: discontinuous flecks of staining
(immune complex)
Linear: smooth continuous staining (non-
immune complex)
Terminology of electron microscope
or fusion of foot process

Foot process effacement: flattening of foot


processes and loss of slit diaphragms
Tubuloreticular inclusions: usually seen in
lupus nephritis
Electron dense deposit:
Basket weave of glomerular basement
membrane: seen in Alports syndrome
Glomerular diseases
Nephrotic syndrome
Minimal change disease, MCD
Focal segmental glomerulosclerosis, FSGS
Membranous glomerulonephritis, MGN (membranous
nephropathy)
Membranoproliferative glomerulonephritis (MPGN)
Nephritic syndrome
Lupus nephritis
IgA nephropathy
RPGN
Post streptococcal GN
Tubulointerstitial diseases
Acute tubular necrosis
Acute pyelonephritis
Chronic pyelonephritis
Interstitial nephritis, drug induced
Cast nephropathy
Etc:
Hypertensive change
TMA (thrombotic microangiopathy)
Amyloidosis
Diabetic nephropathy
Alport syndrome
Chronic kidney disaeses