Membranous GN

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edwinchowyw

Renal pathology tutorial for nephrologists

Health & Medicine Technology

Primary/Secondary Membranous GN ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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An update of this lecture is available at: https://www.slideshare.net/MohammedGawad/membranous-nephropathy-234601451 - Visit our website for more lectures: www.NephroTube.com - Subscribe to our YouTube channel: www.youtube.com/NephroTube - Join our facebook group: www.facebook.com/groups/NephroTube - Like our facebook page: www.facebook.com/NephroTube - Follow us on twitter: www.twitter.com/NephroTube

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CONTENTS, Introduction Necrosis Fates of necrotic cells Patterns of tissue necrosis Causes of cell injury The biomechanism of cell injury Clinicopathological correlations; examples of cell injury and necrosis Apoptosis Causes of apoptosis Apoptosis in physiologic conditions Apoptosis in pathologic conditions Mechanism of Apoptosis The Mitochondrial pathway of Apoptosis The Death receptor pathway of Apoptosis Clearance of Apoptotic cells Examples of Apoptosis Summary References

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MORPHOLOGY OF REVERSIBLE CELL INJURY Common examples of morphologic forms of reversible cell injury are as under: Hydropic change 2. Hyaline change 3. Mucoid change 4. Fatty change (discussed under intracellular accumulations) 1. HYDROPIC CHANGE Hydropic change means accumulation of water within the cytoplasm of the cell. Other synonyms used are cloudy swelling (for gross appearance of the affected organ) and vacuolar degeneration (due to cytoplasmic vacuolation). Hydropic swelling is an entirely reversible change upon removal of the injurious agent. ETIOLOGY This is the commonest and earliest form of cell injury from almost all causes. The common causes include acute and subacute cell injury from various etiologic agents such as bacterial toxins, chemicals, poisons, burns, high fever, intravenous administration of hypertonic glucose or saline etc. PATHOGENESIS Cloudy swelling results from impaired regulation of sodium and potassium at the level of cell membrane. This results in intracellular accumulation of sodium and escape of potassium. This, in turn, is accompanied with rapid flow of water into the cell to maintain iso-osmotic 2. HYALINE CHANGE The word ‘hyaline’ or ‘hyalin’ means glassy (hyalos = glass). Hyalinisation is a common descriptive histologic term for glassy, homo geneous, eosinophilic appearance of proteinaceous material in haematoxylin and eosin-stained sections and does not refer to any specific substance. Though fibrin and amyloid have hyaline appearance, they have distinctive features and staining reactions and can be distinguished from non-specific hyaline material. Hyaline change is seen in heterogeneous pathologic conditions and may be intracellular or extracellular. INTRACELLULAR HYALINE Intracellular hyaline is mainly seen in epithelial cells. 1. Hyaline droplets in the proximal tubular epithelial cells due to excessive reabsorption of plasma proteins in proteinuria. 2. Hyaline degeneration of rectus abdominalis muscle called Zenker’s degeneration, occurring in typhoid fever. The muscle loses its fi brillar staining and becomes glassy and hyaline. 3. Mallory’s hyaline represents aggregates of intermediate filaments in the hepatocytes in alcoholic liver cell injury. 4. Nuclear or cytoplasmic hyaline inclusions seen in some viral infections. 5. Russell’s bodies representing excessive immuno glo bulins in the rough endoplasmic reticulum of the plasma cell EXTRACELLULAR HYALINE Extracellular hyaline commonly termed hyalinisation is seen in connective tissues. 1. Hyaline degeneration in leiomyomas of the uterus. 2. Hyalinised old scar of fi brocollagenous tissues. 3. Hyaline arteriolosclerosis in renal vessels in hyper tension and diabetes mellitus. 4. Hyalinised glomeruli in chronic glomerulonephritis. 5. Corpora amylacea seen as rounded masses of concentric hyaline laminae in the enlarged prostate in the elderly, in the brain and in the spinal cord in old age, and in old infarcts of the lung.

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