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Renal Pathology
Tissue Sampling, Allocation, and Fixative
Sampling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Allocation and Fixatives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Stains
LM- PAS ,[object Object],[object Object],[object Object],[object Object],[object Object]
LM- Masson's trichrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
LM- H&E ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
LM- Silver stain ,[object Object],[object Object],[object Object],[object Object],[object Object]
Approach- Clinical Syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
Approach-
 
 
Renal Biopsy Evaluation ,[object Object],[object Object],[object Object],[object Object]
Types of hypercellularity ,[object Object],[object Object],[object Object],[object Object]
Other important terms in the description of glomerular changes: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Normal Histology Glomerulus
 
Normal Histology
 
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[object Object],[object Object],[object Object],[object Object]
Image of a lobule of the glomerular tuft: red arrows indicate several mesangial areas in which there are 1 or 2 nuclei. Green arrows indicate nuclei of endothelial cells (Masson’s trichrome, X400).
[object Object],[object Object]
The mesangial matrix also stains with the PAS, like the basal membranes, due to the affinity of PAS by type IV collagen (PAS, X300).
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The GBM is seen perfectly smooth, without perpendicular irregularities nor projections (red arrows).  The flat cytoplasm of the visceral epithelial cell can be seen; and in some points, it is possible also to see the cytoplasm of the endothelial cells.  The nucleus of a podocyte appears pointed with the green arrow.  The nuclei of the endothelial cells usually are found towards the mesangial portion of the capillary (blue arrow) (Methenamine-silver)
 
[object Object],[object Object],[object Object]
 
JGA: The yellow arrows indicate the macula densa, see the apical nuclei.  Almost in contact with macula densa cells is the extraglomerular mesangium  indicated with the black arrows. The green arrow marks the efferent arteriole and the blue arrow the afferent arteriole. The Peripolar cells are located exactly in the angle in which parietal epithelium contacts visceral epithelium (H&E, X.400).
Normal Histology Interstitium
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Cortex- Scant interstitium
Medulla- more interstitium
Nerves accompanying the vessels
Normal histology Tubules
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Proximal tubules are characterized to have an abundant, eosinophilic cytoplasm and a brush border easy to identify. The cytoplasmic size, the tall cells and the brush border (arrows) are more prominent in the proximal convoluted portion. (H&E, X400). ,[object Object]
Brush border of the proximal tubules has affinity by the reagents used in the periodic acid of Schiff coloration (arrows). (PAS, X200).
The silver stain emphasizes the basement membranes of tubules and it allows us to delineate the contours very well. The prominent eosinophilic cytoplasm of the proximal tubules contrasts with the clearer and less abundant cytoplasm of the distal tubules (asterisks). (Methenamine-silver stain, X200).
In this image we can see distal tubules at both sides of a thin portion of the thin limb of Henle with a hyaline cast (arrow). In many cases it is very difficult, with light microscopy, to differentiate if small spaces in the medulla, like this here observed, are peritubular capillaries or thin portion  of the limb of Henle. (H&E, X400). ,[object Object],[object Object]
[object Object],[object Object]
Distal tubule and collecting duct cells have less eosinophilic cytoplasm than proximal tubule cells. See a clear halo surrounding the nucleus in many cells. (H&E, X400). ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Vessels
 
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
The arcuate arteries run by the interstitial space between the cortex and medulla, and they are accompanied by lymphatic vessels, nerves and veins (asterisk) (H&E, X100).
The cortical radial or interlobular arteries are branches of the arcuate and originate the afferent arterioles. Usually they have, depending of the thickness of their wall, several layers of muscular cells (H&E, X300).

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Introduction to Renal Pathology

  • 3.
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  • 30. Image of a lobule of the glomerular tuft: red arrows indicate several mesangial areas in which there are 1 or 2 nuclei. Green arrows indicate nuclei of endothelial cells (Masson’s trichrome, X400).
  • 31.
  • 32. The mesangial matrix also stains with the PAS, like the basal membranes, due to the affinity of PAS by type IV collagen (PAS, X300).
  • 33.
  • 34. The GBM is seen perfectly smooth, without perpendicular irregularities nor projections (red arrows). The flat cytoplasm of the visceral epithelial cell can be seen; and in some points, it is possible also to see the cytoplasm of the endothelial cells. The nucleus of a podocyte appears pointed with the green arrow. The nuclei of the endothelial cells usually are found towards the mesangial portion of the capillary (blue arrow) (Methenamine-silver)
  • 35.  
  • 36.
  • 37.  
  • 38. JGA: The yellow arrows indicate the macula densa, see the apical nuclei. Almost in contact with macula densa cells is the extraglomerular mesangium indicated with the black arrows. The green arrow marks the efferent arteriole and the blue arrow the afferent arteriole. The Peripolar cells are located exactly in the angle in which parietal epithelium contacts visceral epithelium (H&E, X.400).
  • 40.
  • 41.
  • 46.
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  • 48. Brush border of the proximal tubules has affinity by the reagents used in the periodic acid of Schiff coloration (arrows). (PAS, X200).
  • 49. The silver stain emphasizes the basement membranes of tubules and it allows us to delineate the contours very well. The prominent eosinophilic cytoplasm of the proximal tubules contrasts with the clearer and less abundant cytoplasm of the distal tubules (asterisks). (Methenamine-silver stain, X200).
  • 50.
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  • 59. The arcuate arteries run by the interstitial space between the cortex and medulla, and they are accompanied by lymphatic vessels, nerves and veins (asterisk) (H&E, X100).
  • 60. The cortical radial or interlobular arteries are branches of the arcuate and originate the afferent arterioles. Usually they have, depending of the thickness of their wall, several layers of muscular cells (H&E, X300).