Professional Documents
Culture Documents
Tract Module
by
Normando C. Gonzaga, M.D., FPSP
Objectives
• To analyze clinical manifestations of renal
diseases utilizing the steps of science
• To be aware of the common glomerular
diseases seen in the Country
• To recognize and describe the gross and light
microscopic appearances of glomerular lesions
• Correlate the above with immunofluorescense
and electron microscopic findings
• To explain the pathogenesis of these lesions
utilizing the basic principles of pathology
• To make a clinico-pathologic correlation
Urine is an ultrafiltrate of plasma.
Blood
Urine
Using the illustration at the left picture, identify the different
components of the normal glomerulus at the right picture as
labeled in the illustration. Identify the lobule and describe the
cellularity.
Below is the PAS stain of a normal glomerulus showing the
normal thickness of the basement membrane. Study the
morphology of the normal glomerulus. This will be used as
reference in recognizing the different light microscopic
abnormalities.
An electron micrograph of the normal glomerulus. Study the
different components especially their relationship with one
another. What are the functions of the mesangial cells?
Another electron micrograph of the glomerulus. Study the
mesangial cells, endothelial cells, and the foot processes,
and their relationship with one another.
Lower magnification of the foot processes, basement
membrane, and visceral epithelial cell. Study well the
structural appearance of the foot processes.
E.M. of the basement membrane. Study the lamina densa,
lamina rara externa, and lamina rara interna. What are the
terms used for dense deposits in the A. lamina densa. B.
lamina rara externa, C. lamina rara interna?
Various types of glomerulonephritis are
characterized by one or more of four basic tissue
reactions.
• Hypercellularity is characterized by one or more
combination of the following:
- Cellular proliferation of mesangial or
endothelial cells
- Leukocytic infiltration, consisting of
neutrophils, monocytes and, in some instances,
lymphocytes.
- Formation of crescent by proliferating
parietal epithelial cells.
Robbins 7th Ed, p 967
A glomerulus showing hypercellularity. Identify the component
cells. High power view of encircled area at right. Predict the
effects physiologic effects of this lesion. What are the expected
findings in the urine?
Crescent formation. Black arrow indicates the crescent.
Identify the compressed glomerulus. What cell is proliferating?
If a large percentage of the glomeruli shows this lesion,
predict the pathophysiologic effects.
Various types of glomerulonephritis are
characterized by one or more of four basic tissue
reactions.
2. Basement membrane thickening appears as
thickening of the capillary wall, best seen in
sections stained with periodic acid Schiff (PAS).
This thickening may be due to:
- deposition of amorphous electron dense
material, most often immune complexes on the
endothelial or epithelial side of the basement
membrane or within the GBM itself.
- thickening of the BM proper, as occurs in
diabetes glomerulosclerosis.
Robbins 7th Ed, p 967
Basement membrane thickening in which the capillary
loops are thickened and prominent, but the cellularity is
not increased.
Combined hypercellularity and membranous thickening of
the glomerulus (membrano-proliferative lesion). Identify
the lesion. What cell are proliferating? Predict the
physiologic effects and expected findings in the urine?
Various types of glomerulonephritis are
characterized by one or more of four basic
tissue reactions.
3. Hyalinization and Sclerosis denote the
accumulation of material that is homogeneous
and eosinophilic by light microscopy. By
electron microscopy, the hyalin is extracellular
and consists of amorphous substance, made
up of protein plasma. It is typically the end
result of various forms of glomerular injury. It
can be (1) diffuse, (2) segmental, (3) global,
and (4) mesangial.