14. Blood supply of Kidney. Brödel's 1901 artist rendition of a human left kidney anterior view, following celloidin injection with tissue digestion, demonstrating details of the lush venous return. For the sake of clarity, he omitted the small veins of the cortex (Brödel M. Johns Hopkins Hospital Bulletin 1901; 118 :10–13). Arcuate BV Note arcuate large vessels in medulla, But, small straight vessels in cortex. (revise physiology of urine production, counter current mechansim)
38. Great achievements can start right where you stand, by applying the habit of going the extra mile, by rendering more service and better service than you are now being paid for. Napoleon Hill
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40. Minimal Change GN: Introduction Synonyms: Incidence: Etiology: Clinical Features: Lab Features: Pathology: Clinical Course: Nil disease, lipoid nephrosis, foot process disease Idiopathic. Loss of net negative charge destruction of podocyte foot processes. Nephrotic syndrome. History of recent URI in 30%. Association with Hodgkin’s lymphoma. Overlap with FSGS patients. Nephrotic urine (polyuria, Selective proteinuria. (albuminuria). Spontaneous remission in 25-40%. Complete remission in 65-70% of patients. Steroid resistant patients may progress to FSGS. LM - Normal. IF - Negative. EM - Focal fusion/loss of foot processes. 80% of nephrotic syndrome in children (1-8 yrs.), mostly male. Adults in 2nd-3rd decade.
42. Focal Segmental GN: Adults Synonyms: Incidence: Etiology: Clinical Features: Lab Features: Pathology: Clinical Course: Focal segmental Sclerosis Idiopathic - ? Auto Immune. No deposits. (Similar to minimal change). Nephrotic syndrome. History of recent URI in 30%. Association with Hodgkin’s lymphoma. Overlap with MCD patients. Nephrotic urine (more, clear) Selective proteinuria. No specific laboratory findings. Spontaneous remission 30% , 50% progression to chronic renal failure, 20% rapid progression. Podocyte damage, Segmental collapse of glom. increase in matrix (pink). 10 - 35% of nephrotic syndrome in adults.
43. Membranous GN: Synonyms: Incidence: Etiology: Clinical: Lab: Path: Clinical Course: Epimembranous, extramembranous GN Immune complex deposition. Idiopathic in most patients, associated with infections, drugs, carcinomas, and heavy metals. Nephrotic syndrome in 80%, asymptomatic proteinuria in 20%. Microscopic hematuria. Non-selective proteinuria ± hematuria. Excellent prognosis in children. Some adults develop ESRD. Exclusion of other diseases is required. Diffuse, uniform BM thickening with subepithelial projections (“spikes”). Diffuse, coarsely granular IgG and C3 deposits along basement membranes. Electron-dense subepithelial deposits. 40-60 Years, 50% of adult nephrotic syndrome. Wireloop
45. Membranoproliferative GN: Etiology: Chronic immune complex GN. Associated with chronic infections, SLE, cancer, cirrhosis, heroin abuse, etc. Clinical: Nephrotic syndrome in 50%, acute nephritic syndrome in 20%. Recent history of URI in 50%. Hypertension and/or renal insufficiency. Lab: Hypocomplementemia of classic and alternate pathways. C3 nephritic factor (C3NEF). Circulating immune complexes. Clinical Course: Progressive deterioration of renal function ± short remissions. ESRD within 10 years in 50% of children and 80% of adults. Path: Diffuse proliferative GN with thickening of the glomerular capillary walls,, and GBM splitting (“tram-tracking”). Diffuse, coarsely granular C3 and IgG deposits along GBMs. Electron-dense subendothelial deposits. Incidence: Children and young adults (5-25 years).
46. MPGN-Tram tracking Arrow: Mesangial cell proliferation, basement membrane thickening, leukocyte infiltration, and accentuation of lobular architecture. Type 1 – Most common 80% Type 2 – Dense deposit disease (C3)
47. MPGN-Tram tracking Glomerulus PAS stain to highlight the glomerular basement membranes. Observe the glomerular capillary loops showing two basements membranes giving the loops a tram track appearance (arrow).
88. "If you tell the truth, you have infinite power supporting you; if not, you have infinite power against you. --Charles Gordon
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107. “ The worst times in your life contain seeds of the best. When you can see crisis as an opportunity, your life becomes not only easier, but more satisfying.” –Joe Kogel
108. Video tutorials on Digital Pathology Slides on Acknowledgements: You Tube WashingtonDeceit: Dedicated to the greatest pathologist of all time - Martin A. Swerdlow , MD "Build it and they will come."
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110. Challenge….! Jan 2009: 4 th Year Students at JCU School of Medicine set new world record.…!!! 100% Pass & Class Average of over 70% Winners Club is still active….! - Email me