URINARY TRACT OBSTRUCTION

Gen Path (dra Tesoro)

Importance
Kidneys
1. Increased susceptibility to infection
2. Increased susceptibility to obstruction
3. Obstrcution may lead to atrophy

Intermediate mesoderm Hydronephrosis: dilatation of the renal pelvis and

a. pronephric kidneys – cords of cells calyces
cervical and thoracic regions
DEVELOPMENT OF THE KIDNEYS
pronephric duct
b. mesonephric kidneys
series of tubules and tuft of
vessels from the aorta
mesonephric duct
c. metanephric kidneys
ureteric bud
metanephric blastema

CONGENITAL ANOMALIES

1. Agenesis of the kidneys UROLITHIASIS

2. Hypoplasia Four main types of calculi
3. Ectopic kidneys 1. Calcium containing
4. Horse shoe kidneys: fusion 2. Struvite stone/triple stones
of either the upper pole or 3. Uric acid
the lower poles anterior to 4. Cystine
the great vessels Staghorn calculi : stone in the renal pelvis
- common

RENAL CYSTIC DISEASES

(See Table 1 at the last page)
Importance
1. common diagnostic problem
2. major cause of CRF
3. confused with malignant tumors

TUMOURS OF THE KIDNEY

• Benign
1. Renal papillary adenoma
2. Renal fibroma
3. Angiomyolipoma
4. Oncocytoma

• Malignant
1. Renal cell carcinoma
1. Clear cell
2. Papillary
3. Chromophobe
4. Collecting duct
2. Urothelial carcinoma of the pelvis
1. Squamous cell carcinoma
2. Transition cell carcinoma

FUNCTIONS
Sometime in december
• Filtration of small molecules from blood plasma
to form a filtrate
• Selective reabsorption of most of the water and
other molecules from the filtrate; leaving behind
excess and waste materials to be excreted
 • Secretion of some secretory products directly
from blood into filtrate

THE GLOMERULAR CAPILLARY WALL IS THE

FILTERING MEMBRANE AND CONSISTS OF THE
FOLLOWING STRUCTURES:
1. A thin layer of
fenestrated
endothelial cells

each fenestrum being

about 70 to 100 nm in
diameter.

Important Implications of Blood Supply

1. End-arteries, occlusion of any branch usually
results in infarction of the specific area it
supplies
2.Glomerularbasement
2. Glomerular disease that interferes with blood membrane (GBM)
flow through the glomerular capillaries has
profound effects on the tubules, within both the a. lamina densa - a
cortex and the medulla, because all tubular thick electron- dense
capillary beds are derived from the efferent central layer
arterioles
3. Blood supply to the renal medulla render them b.thinner electron-lucent
especially vulnerable to ischemia peripheral layers:
lamina rara
NEPHRON interna
• Functional unit of the kidney lamina rara
• Consists of externa
– Renal corpuscle
• Bowman’s capsule
• Glomerulus
– Renal tubule
• Proximal convoluted tubule
• Loop of Henle
• Distal convoluted tubule GBM
• Collecting tubule consists of collagen
(mostly type IV), laminin,
GLOMERULI polyanionic proteoglycans
• anastomosing network of 20 to 40 capillary loops (mostly heparan sulfate),
arranged in several units or lobules fibronectin, entactin, and
architecturally centered by a supporting several other
mesangial stalk glycoproteins
• lined by fenestrated endothelium invested by
two layers of epithelium Type IV collagen forms a
a. visceral epithelium is incorporated into and network suprastructure to
becomes an intrinsic part of the capillary which other glycoproteins
wall, attach
b. parietal epithelium,
- situated on Bowman's capsule The building block
- lines the urinary space, the cavity in (monomer) of this
which plasma filtrate first collects network is a triple-helical
molecule made up of
three α-chains

determines its
permeability characteristics.

3. visceral epithelial cells

(podocytes)
are structurally complex cells that possess interdigitating
processes embedded in and adherent to the lamina rara
externa of the basement membrane.

Adjacent foot processes (pedicels) are separated by 20-

to 30-nm-wide filtration slits, which are bridged by a thin
diaphragm

4. mesangial cells
> supports the entire glomerulus
> Basement membrane-like mesangial matrix forms a
meshwork through which the mesangial cells are
centered
> mesenchymal origin
contractile \ phagocytic
capable of proliferation
can lay down both matrix and collagen
secrets a number of biologically active
mediators
> akin to vascular smooth muscle cells and pericytes
 STAINS • (Albumin, Kappa, lambda)

H and E

MTS

ELECTRON MICROSCOPY
• One-micron thick sections (semi-thin sections)
– Toluidine blue
• Ultra-thin sections
COMPARTMENTS
• Glomeruli
• Tubules
• Interstitium
PAS • Blood Vessels

Glomeruli

- Hypercellularity
PAS (mesangal,
endothelial,
epithelial,
inflammatory cells)
- Glomerulos
clerosis (segmental,
global)
- GBM abnormality
(thickening, double
contour, wire loops,
rupture)
- Bowman’s capsule

Tubules

- Tubulitis
- Tubular atrophy
- Tubular necrosis
- Casts
- Inclusion bodies
- Vacuolations
PAAg - Calcifications
IMMUNOFLUORESCENCE MICROSCOPY
• Immunoglobulins
– IgG, IgA, IgM
• Complements
– C3, C1q Interstitium
• Fibrinogen -
-
- - Fibrosis
- - Edema
- - Inflammatory cells
- - Hemorrhage

Blood Vessels
Global

- - Arteries, veins,
arterioles,
- - capillaries
- Vasculitis
- Fibrinoid necrosis
- Thrombi
- Fibrosis

Segmental

DEFINITION OF TERMS

Diffuse

Focal