#MICROSCOPIC

#Diagnosis 👉🏻 Acute tubular injury and necrosis


#The_black_arrow
Regenerative tubular

#The_blue_arrow
Obstruction tubule
Filled with fibrin debris or hyaline casts

DIABETIC NEPHROPATHY
Is morphologic structural change in the kidney , and caused
- nephrotic syndrome
- pyelonephritis
- Interstitium inflammation
- papillary necrosis
- atherosclerosis 👇🏻
وهذا بسبب hyperlipidima الذي يعمله


✫Microscopic Description
- Diffuse sclerosis
- deposition of glycogen in tubules
- Interstitium inflammatory cells and fibrosis
- Thickening in the tubules , glomerular and bowman capsule BM
- mesangial matrix expansion
- Nodular lesions (kimmelstil-wilson lesions)
- Vascular hyalinosis
- Hyalinosis of afferent and efferent arterioles

#MICROSCOPIC

#Diagnosis 👉🏻 diabetic nephropathy

#The_black_arrow
Thickening in BM of bowman capsule

#The_blue_arrow
Mesangial matrix expansion

#The_white_arrow
Fibrosis

#The_yellow_arrows
Thickening in BM of tubules

#MICROSCOPIC

#Diagnosis 👉🏻 diabetic nephropathy

#The_black_arrow
Nodular lesions (kimmelstil-wilson lesions)

#The_white_arrow
Fibrosis and inflammatory cell

#MICROSCOPIC

#Diagnosis 👉🏻 diabetic nephropathy


#The_black_arrows
Thickening in BM of tubules

#The_blue_arrows
Fibrosis and inflammatory cells

#MICROSCOPIC

#Diagnosis 👉🏻 diabetic nephropathy

#The_black_arrow
Vascular hyalinosis

#The_blue_arrow
Thickening in BM of tubules

#The_yellow_arrows
Inflammatory cells and fibrosis

#MICROSCOPIC

#Diagnosis 👉🏻 diabetic nephropathy

#The_large_arrow
Hyalinosis of afferent arterioles

#The_small_arrow
Hyalinosis of efferent arterioles

THE FIRST LAB DONE  ✓✓

العلامات المميزة لكل مرض في الرينال..

NEPHROTIC SYNDROME
𖣔 Caused
- Masive Proteinuria
- hyperlipidemia
- severe edema (anasarca)

𖣔 Cause
𖦹 Primary
• Membranous nephropathy
• Manimal changes disease
• focal segmental glomerulosclerosis
• Membranoproliferative glomerulonephritis

𖦹 Secondary
- diabetic nephropathy
- Immunologic disease


•°•°•°•°•°•°•°•°•°•°•°•°•°•°•°•°•°•°•°•°

MINIMAL CHANGE DISEASES
( Lipoid nephrosis )

✫ Definition
Idiopathic glomerular disease that causes nephrotic syndrome

Most common type of nephrotic syndrome in children


✫ Gross description
Enlarged, waxy yellow cortex due to lipid accumulation in proximal tubules

✫Microscopic description
- Glomerulus normal
- No tubular atrophy
- No interstitial scarring
- Lipid droplets deposetion in tubules
By Periodic acid - methenamin sliver stain (Jones stain)
- BM & Mesangial matrix ➪ black
- epithelium cell & mesangial cell ➪ grey pink


✫Electron microscopy description
- foot process of podocyte effacement
- Normal fenestrated
- Normal BM in thickness

✫Immunofluorescence
Negative

..

#MICROSCOPIC

#Diagnosis 👉🏻 Minimal change disease

#The_blue_arrows
Fat droplets in tubules

#The_black_arrows
lipid laden macrophages in the interstitium

#ELECTRON_MICROSCOP

#Diagnosis 👉🏻 Minimal change disease
OR
Focal segmental glomerulonephritis

#The_black_arrow
Foot processes effacement

#The_blue_arrow
BM

#The_red_arrow
Fenestrated endothelium

#The_yellow_arrow
Electron dense RBCs

#MICROSCOPIC

#Diagnosis 👉🏻 Minimal change disease


#The_black_arrow
Normal glomerulus

#Type_of_stain
H&E stain

#MICROSCOPIC

#Diagnosis 👉🏻 Minimal change disease

#The_yellow_arrows
mesangial cell

#The_red_arrows
BM

#The_black_arrow
Podocyte

#The_blue_arrows
epithelium cell

#Type_of_stain
Periodic acid-methenamin sliver stain (Jones stain)

#صورة_اكثر_وضوحاً
#MICROSCOPIC

#Diagnosis 👉🏻 Minimal change disease

#The_asterisks
Capillary loops are mildly ectatic

#The_black_arrows
podocyte

#The_red_arrows
mesangial cells

#The_blue_arrows
Fat droplets

FOCALE SEGMENTAL GLOMERULOSCLEROSIS

Causes 10% of nephrotic syndrome in children , 20% in adults

✫Microscopic description
- Increased mesangial cells (proliferative) , and mesangial matrix
- Hyaline deposition (hyalinosis)
- collagen deposition show by trichrome stain
- obliterated capillary lumina
- foamy (lipid-laden) macrophages
- Focal and segmental
sclerosis that appear to adhere to Bowman capsule
- tubular atrophy with interstitial fibrosis

و يظهر ايضاً morphologic variant يلي يدعى collapsing glomerulopathy والذي يتميز بـ collaps of glomerular tuft
والذي يعتبر more severe manifestation of FSGS

✫Immunofluorescence
Positive

..

#MICROSCOPIC

#Diagnosis 👉🏻 Focal segmental glomerulosclerosis
(Collapsing)

#The_yellow_arrows
mesangial cell

#The_black_area
sclerosis adhere to Bowman capsule

#The_blue_arrows
Podocyte

#The_black_arrow
Sclerosis

#Type_of_stain
Periodic acid schiff (PAS)

#MICROSCOPIC

#Diagnosis 👉🏻 Focal segmental glomerulosclerosis
(Collapsing)


#The_black_arrow
Sclerosis

#Type_of_stain
Jones stain