Chapter 11 Diseases of Urinary System
Observational methods of specimen
The urinary system consists of the kidneys, the ureters, the urinary bladder and the urethra.
Kidneys. The kidneys are a pair of bean-shaped, reddish-brown (gray-colored after fixing) organs. The volume of normal kidney is about 11cm×6cm×3cm, weight 120g. The renal cortex is about 0.5cm in thickness, and the cut surface reveals a clearly defined outer cortex and an inner medulla. Near the renal hilum are renal pelvis and calyces, which are deerhorn-shaped and the mucosa is pale, smooth and thin. The capacity of the renal pelvis is about 10 ml. When observing we should note: ①The shape, size, texture and surface color of the kidneys; ②Whether there is any adhesion in the fibrous capsule; ③Whether the surface is smooth, or if it has any nodes or depressions; ④whether the membrane thickened, the thickness of cortex and whether the cortex and medulla are clearly defined; ⑤Whether there is focal pathological change in the renal cortex and medulla, noticing the size, shape, color, texture of the pathological change and the relationship to its surrounding
s; ⑥ Whether the renal pelvis is enlarged, whether there is foreign matter in the cavity of renal pelvis, whether the mucosa is smooth (whether there is exudation) or thickened.
The glomerulus of a normal adult kidney is about 217μm in diameter, each having 48-100 nuclei (in children about 80). The afferent arteriole enters the glomerular tuft and breaks into about 5-8 branches, which, in turn, branch into the anastomosing capillary network of each of the eight glomerular lobules. The capillary network is petaloid; the proximal convoluted tubule lies around the glomerulus and is lined by single taper epithelial cells which are vague in border and cytoplasm acidophilic (distal convoluted tubule weaker than it); the Bowman’s capsule is lined by capsular squamous epithelial cells, and inner visceral epithelial cells which cover the external surface of each glomerular capillary (that is podocyte); the renal interstitium consists of connective tissue, capillary and vein. Note: ①Whether the capsule undergo proliferation of connective tissue; ②The plentiful condition of glomerular capillary; Whether the endothelium and the mesangial cells is swelling or proliferative, whether inflammative cells infiltrating, basement membrane thickening, fibrous tissue proliferating, adhesion between walls of Bowman’s capsule and
renal glomerulus, diffusive or segmental pathology;③Whether there is renal tubule epithelium’ degeneration, necrosis and unusual matter deposition in cavity of tubule; ④ Inflammative cells infiltrating and connective tissue proliferating; ⑤Tumor and other changes.
Ureters. The ureters are about 20-30cm in length; 0.5-1.0cm in diameter. The wall is thin. Note: ①Whether the cavity becomes enlarged or narrow, and whether there is foreign matter;②Whether mucosa is smooth (whether there is exudation); ③ Whether the wall becomes thin or thick; ④Whether there is focal pathological change in the wall.
Urinary bladder. The urinary bladder is a hollow organ. There are many different folds on the mucosa of its internal surface, but on the fundus of bladder there is a smooth triangular area called the trigon of bladder. Note: ① Whether the mucosa is smooth (whether hyperemia, hemorrhage, ulcer, neoplasm, exudation can be observed); ②Whether the wall becomes thin or thick.
Aims
1. To grasp the features of pathological changes and their relationship with clinical manifestations of acute diffuse proliferative glomerulonephritis, crescentic glomerulonephritis and chronic sclerosing glomerulonephritis.
2. To grasp the features of pathological changes, development and their relationship with clinical manifestations of acute and chronic pyelonephritis.
3. To understand the features of pathological changes of membranous glomerulonephritis and membranoproliferative glomerulone phritis.
4. To understand the knowledge about tumor of the kidney and the urinary bladder.
ContentS
Gross specimen
Tissue section
Glomerulonephritis
Acute diffuse proliferative GN
Acute diffuse proliferative GN
Crescentic GN
Crescentic GN
Chronic sclerosing GN
Chronic sclerosing GN
Membranous GN
Membranous GN
Membranoproliferative GN
Pyelonephritis
Acute pyelonephritis
Acute pyelonephritis
Chronic pyelonephritis
Chronic pyelonephritis
Tumor of kidney
Renal cell carcinoma
Renal cell carcinoma
Nephroblastoma
Nephroblastoma
Carcinoma of bladder
Carcinoma of bladder
Transitional cell carcinoma
Key POINTS OF specimen observation
1. Glomerulonephritis
(ⅰ) Acute diffuse proliferative glomerulonephritis
Basic pathologic changes
proliferation
(1) Gross morphology
◆The kidneys are swollen, with the fibrous capsule tense and smooth, which may be congested, so that it is called big-red kidney; In some cases, there are many scattered punctate hemorrhage on the surface, so that it is called louse-bitten kidney;
◆The cut surface reveals the thickened cortex and a clear border of cortex and a medulla.
(2) Histopathology
◆Almost all of the glomeruli are involved;
◆The glomeruli are distended. Number of cell increases, which is due to the proliferation and swelling of mesangial, endothelial and epithelial cells together with a variable infiltration of neutrophils and monocytes. Some glomeruli may show proliferation of cells lining Bowman’s capsule;

版权声明：本站内容均来自互联网，仅供演示用，请勿用于商业和其他非法用途。如果侵犯了您的权益请与我们联系QQ:729038198，我们将在24小时内删除。