Gu Skills Lab 2 For Lru

Skills Lab 2: Pathology of the Urinary System Prepared by: Normando C. Gonzaga, M.D., F.P.S.P.

Normal Glomerulus  

Slides3, 4, 5, and 6 show normal glomerulus. Slide # 3 shows a single glomerular lobule under high magnification. The mesangial stalk is in the center. Two nuclei of mesangial cells(MC) are visible as well as small strands of mesangial matrix. The matrix(MM) forms thin discontinuous lines separating the mesangium from from the capillary lumina. Endothelial cells(En) are seen in two of the capillaries. Epithelial cells (podocytes) (P) are attached to the basement membran(BM). Bowman’s capsule(BC) is present in the left upper corner. X2,000.

Normal Glomerulus 

Slides # 5 shows an electron micrograph of the mesangial stalk. Two mesangial cells(MC) are present together with strands of mesangial matrix(MM). The basement membrane covering the mesangium is somewhat wrinkled and is covered by foot processes of the podocytes(P). X12,000.

Normal Golmerulus 

Slide # 7 shows an electron micrograph of a part of a capillary showing the endothelial lining, the basement membrane(BM) and the foot processes(FP), some of which are attached to the cytoplasm of the podocytes(P). Bowman’s capsule(BC) with its basement membrane and the parietal epithelial cells are also visible. X12,000

Normal Glomerulus 

Slide # 9 shows an electron micrograph of a part of a glomerular capillary wall under higher magnification. Endothelial pores are visible in places. The basement membrane shows three layers: lamina rara interna(LRI), lamina densa(LD), and lamina rara externa(LRE). U:urinary space, L: capillary lumen, FP:foot processes X18,000

Slide 

Slide # 11 shows the typical diffuse proliferative endocapillary glomerulonephritis. There is marked cellularity caused by increased epithelial, mesangial, and endothelial cells. Also note the numerous polymrophonuclears and lymphocytes in the glomerulus. H&E stain X260

Acute Post-streptococcal Glomerulonephritis 

Slide #13 shows immunofluorescence microscopy. Numerous large and small granular, diffusedly distributed deposits of IgG are seen along the capillary loops.

Acute Post-streptococcal Glomerulonephritis 

Slide # 15 shows an electron micrograph of a part of a glomerular lobule. Note the polymorphonuclears(PMN) inside the capillary. Many deposits (“humps”) (D) of various sizes are present along subepithelial area of the basement membrane. MC:mesangial cells, En:endothelial cell, MM:mesangial matrix, P:podocyte X2,900.

IgA Nephropathy 

Slide #17 shows an immunolfuoresecnce microscopy showing deposits of IgA in the mesangium and few deposits in the basement membrane.

IgA Nephropathy 

Slide #19 shows a glomerulus showing mesangial widening and mild mesangial cells proliferation. This is a diffuse mesangial proliferative pattern of IgA. PAS stain X 260

IgA Nephropathy 

Slide #21 shows segmental cell proliferation and sclerosis with adhesion to Bowman’s capsule. This is another light microscopic pattern of IgA nephropathy. PAS stain X260

IgA Nephropathy 

Slide #23 shows an electron micrograph demonstrating the characteristic mesangial and paramensangial electron dense deposits(D) in IgA. BM:basement membrane, L:lumen, U:urinary space. X11,000

Minimal Change Glomerulonephritis 

Slide #25 shows an electron micrograph with a glomerular cpillary loop showing the extensive effacement of the epithelial foot processes(FP), microvilli (MV) in the urinary space(U) and edema of the podocyte(P) and endoethlial cell(En). BM:basement membrane. X17,000

Minimal Change Glomerulonephritis 

Slide # 27 demonstrates a scanning electron micrograph which shows diffuse effacement of foot processes. The microvilli are also prominent.

Membranous Glomerulonephritis 

Slide # 29 shows a glomerulus with marked thickening of the capillary walls with little or no cellular proliferation. PAS stain X320

Membranous Glomerulonephritis 

Slide #31 shows capillary loops of a glomerulus showing numerous pink subepithelial deposits and black spikes. PAM stain X1,000

Membranous Glomerulonephritis 

Slide # 33 shows immunofluorescence microscopy showing diffuse granular deposits of IgG along the capillary walls. X260

Membranous Glomerulonephritis 

Slide #35 shows an electron micrograph showing large subepithelial deposits (D) and spikes (S) along the basement membrane. The foot processes(FP) are focally effaced. L:capillary lumen X16,000

Membranoproliferative Glomerulonephritis 

Slide #37 shows expansion of mesangial matrix with accompanying lobulation. Note also the increase number of mesangial cells. In some places the walls have double outlines. PAS stain X 260

Membranoproliferative Glomerulonephritis 

Slide #39 shows a high magnification of a glomerulus with distinct “double contour” of capillary loops.

Membranoproliferative Glomerulonephritis 

Slide #41 shows en electron micrograph demonstrating the double outline of capillary walls due to subendothelial mesangial extension into the basement membrane(BM). MM:mesangial matrix, MC:mesangial cell, L:capillary lumen

Membranoprolifeative Glomerulonephritis 

Slide #43 shows an electron micrograph demonstrating the subendothelial electron dense deposits (D). BM:basement membrane, MC:mesangial cell, P:podocyte

Membranoproliferative Glomerulonephritis 

Slide #45 shows an electron micrograph demonstrating electron dense deposits in the lamina densa forming ribbon-like formation in the basement membrane. This is seen in MPGN Type 2(Dense Deposit Disease). P:podocyte, BM:basemen membrane, MM:mesangial matrix, FP:foot processes X7,000

Membranoproliferative Glomerulonephritis 

Slide #47 shows an electron micrograph demonstrating marked disruption of basement membrane by gray staining deposits(D). Remnant of lamina densa are represented by thin strands which stain black. MPGN Type 3 FP:foot process, MC:mesangial cell X15,000

End-stage Renal Disease 

Slide #49 shows an end stage kidney. Note the nearly global sclerosis of glomeruli, extensive tubular atrophy, thickening of the arterial walls, and focal fibrosis. PAS stain X100

Wilms’ Tumor 

Slide #51 shows a section of a Wilm’s tumor. Note the rudimentary glomerular (“glomeruloid”) structures (arrows) and a loose immature spindle cell stroma (e.g. lower right). Tubules and muscular elements are often also present. H&E X300

Renal Cell Carcinoma 

Slide #53 shows a section of renal cells carcinoma. Note the large pale cells with abundant cytoplasm (clear cell pattern) due to abundant lipid and glycogen.

Transitional Cell Carcinoma 

Slide #55 demonstrates a section of transitional cell carcinoma. It is a papiliform lesion consisting of short broad papillae. They have fibrovascular core covered by transitional epithelium several times thicker than the normal epithelium. This tumor arises from the sites originally lined by transitional epithelium such are the renal pelvis, ureter, bladder. It reprpesents about 90% of bladder tumor.