Pathologic anatomy of the kidney

Atrophy of the kidneys in its pure form is rare. More often it is associated with circulatory disorders, and chronic inflammation in the kidneys. Meet atrophy kidney senile and from starvation. When atrophy kidney macroscopically reduced, with solitary cysts. Pronounced Wakata hypertrophy perinephral of fiber, which helps to distinguish atrophy from hypoplasia. Microscopically observed zapustevanie nephrons with glomerular sclerosis and the growth of connective tissue, very rich in cellular elements in the cortical layer of the kidneys. Cerebral layer often with areas of hyalinosis. Atrophy is often a result of hydronephrosis. Hypertrophy P. often has a compensatory character and is related to the change or the lack second P.
Degenerative disorders of the kidney are found at various violations of the currency.
Violation of protein metabolism accompanied by the development of the painting cloudy swelling or granular dystrophy kidneys (see Degeneration of cells and tissues). P. increased, with a wide swollen cortical layer, capsule slips when the incision is easy. Microscopically in the epithelium convoluted tubule is weakly expressed grain, celebrated spherical transformation of mitochondria in the epithelial cells. Galinova-drip dystrophy occurs when diphtheria, infectious polypeptidesee, tuberculosis.
Fat metabolism disorders are manifested in the appearance of droplets of fat in a convoluted tubule epithelium. Infiltrative obesity kidney is in the pathology of endocrine glands (for example, lipemia diabetes), in the administration of chloroform, arsenic, phosphorus. Gipotermicescoe obesity kidney observed in pernicious anemia, altitude disease, diffuse thyroid goitre. A special kind is the so-called fat myocardial papillae P. associated with a sharp disorders, cholesterol metabolism (hypercholesterolemia). Macroscopically in sobachko - extensive whitish-yellow fields, Mat kind in the section, are usually clearly separated from the surrounding tissue, wedge-shaped. Microscopically in interstitial tissue and private membrane direct tubules and collecting tubes - massive deposits of cholesterol.
Carbohydrate metabolism is expressed in the development of the so-called glycogen nephrosis diabetes when convoluted tubule epithelium, Genle hinges and the collecting tubules there is an abundance of glycogen. When glycogenoses Guirec kidney doubles and blocks of glycogen is occupied by the kidney, and the tubular epithelium throughout the nephron.
Violations salt metabolism lead to the formation of kidney stones or local processes of calcification by type dystrophic (necrotic nephrosis). Rich leaching lime in the blood, seen with bone tumors (primary or metastatic to bone) or when illness of Recklinghausen, accompanied lime metastases in Petrograd in the body that produce acid valence. In old age is observed calcium deposition in the form of grains in galinadiamond interstitial tissue of the kidney and its own membrane collective tubes, sometimes combined with fatty heart attack. Macroscopic picture of the calcification gave rise to the term "lime heart attack." The deposition of uric acid salts picture of the causes of uric acid heart attack.
Violations of pigmentary exchange are expressed in the painting pigment argued. Gemosideros kidney is a private demonstration common gemosideroze.
Disorders of water exchange is closely connected with the violation of the colloidal state convoluted tubule epithelium and give a picture of the so-called hydropic nephrosis.


Fig. 1. Cystic kidney. Fig. 2. Tuberculosis of the kidneys. Fig. 3. Solitary carbuncle kidneys. Fig. 4. Congestive kidney.

Circulatory disturbances in Petrograd most often expressed in hyperemia (arterial and venous, see printing. Fig. 4), ischemia, heart attacks and hemorrhages.
Anemia (ischemia) kidney - private manifestation of a General anemia or local impaired patency of the renal artery (trauma, atherosclerosis, inflammatory changes). Microscopically in a convoluted tubule epithelium can be observed large multinucleated cells, protruding into the lumen of the tubule and considered as some kind of regeneration of renal epithelial cells in the anoxic conditions.
Heart attacks kidneys are the arterial, venous and traumatic. Blood associated with the closing of the lumen of the renal artery or smaller branches. They always ischemic. Venous infarction, usually hemorrhagic, are connected with violation of venous outflow, the cause of which is the stasis and thrombosis of the branches of the renal vein. Vein thrombosis on, are not always accompanied by the development of myocardial infarction: in terminal thrombosis, he has no time to develop, slow thrombosis formed a wide collaterals, but it can be secondary thrombosis of the renal arteries and the emergence of ischemia and hemorrhagic infarction., In the basis of thrombotic heart lies angiospazm reflex occur in response to the traumatic action of the agent. About his leading role evidenced by the appearance of the contralateral heart attack if the injuries. Traumatic heart attacks are rare. Small heart attacks occur when nodular the nodosa or obliterating endarteritis with the localization process in kidneys. Bleeding in the parenchyma observed in hemorrhagic diathesis, intoxication (meningococtsemiya, diphtheria, etc.,). Haemorrhagic nefrosonefrit bilateral massive hemorrhages in the stroma of the pyramids capture often entirely maleyeva pyramids and pelvis of the kidney, accompanied hematuria and violations mocheotdelenia up to anuria.
Inflammation of the kidneys may be acute or chronic. Acute inflammation (usually purulent) associated with hematogenous, lymphogenous, urinogenous and interstitial spread of infection. From limited purulent processes are most often found abscesses (single or multiple). Single localized or in cortical, or in the cerebral layer, multiple scattered throughout P. They greenish-yellow with red Corolla, clearly distinguished from the intact parenchyma. Merging, abscesses form carbuncle kidneys (printing. Fig. 3), which is a massive site, fluktuiruyushchimi, purple-bluish color. Chronic course it may be complicated purulent parametriem. Lymphogenous the spread of the infection leads to so-called lymphogenous necrosis of the kidneys. However P. sharply increased, swollen, hyperemic, with a few small abscesses. Microscopically in cortical and brain layers - extensive field necrosis with leukocyte infiltration around them. Lymphangitis kidneys may be complicated by the development of secondary purulent panarteritis and anfibia with further aposematism nephritis.


Chronic inflammation of the kidneys may be nonspecific [chronic pyelonephritis, (see)] and specific (tuberculosis, syphilis , and so on). Acute miliary TB P. developed by hematogenous generalization, clinically bessimptomnom. The function of P. if it is not broken. Surface P. covered with small providename tubercles on the background of hyperemia. Microscopically this is a typical TB tubercles. As the elimination of miliary tuberculosis in the kidney does not remain visible signs. With haematogenous dissemination a chronic tuberculosis of the kidneys, with clear clinical picture. In cortical and brain layers P. macroscopically defined large grayish-white nodes with yellow fields in the center - the so-called focal, or twisted form. When positive immunological reactions of the organism of microscopic picture shows mainly the productive nature of the process, which tends to the limit. More often, however, it has the character of exudative with massive melting of caseous lesions, breakthrough caseous masses in the pelvis and caving - cavernous-ulcer tuberculosis (printing. Fig. 2). Microscopically in the wall cavity, along with the fields exudative inflammation determined bumps in different stages of development, from fresh to cicatrizing. If the scar fields extend to the pelvis, it may be narrowing of the estuaries of the ureters, and develops the so-called gidroenergeticheskiy form of tuberculosis of the kidneys. While kidney resembles a thin bag, filled with greenish-yellowish pus mixed with curd-like masses (TB Pioneros). In extremely rare chronic tuberculosis P. no bumps, necrosis and caverns, and there is a picture of diffuse infiltration stroma epitelialna and lymphoid cells - the so-called interstitial nephritis, or Kahovsky nephrocerus (fibro-indurativnyy form of tuberculosis of the kidneys). About its specific nature, says the discovery of the tubercle Bacillus in the interstitium at colouring by Zn. Tuberculoma P. represents a single node, exciting cerebral layer and bark, tend to encapsulate and subsequent calcification.
In secondary syphilis may develop syphilis interstitial fibrosis jade. Kidney thus increased, light brown color, with no borders between cortical and brain layers. Microscopically - picture swelling of interstice with focal infiltration his lymphoid, plasma cells, and fibroblasts. The outcome of the process is nephrocerus. Tertiary syphilis leads to the formation of the Isthmus of gum (solitary and miliary), located in cortical and brain layers in the end that there scar disfigurement of the kidneys.
The actinomycosis occurs when the transition process in Petrograd from the intestines. In rare cases, it may be complicated purulent parametriem.
When Wegener's granulomatosis kidney may develop granulomatous peripheralid representing periarteriit inflammation afferent vessels of up. When cytomegaly., in a convoluted tubule epithelium and in the glomeruli appear giant cells with nuclear inclusions with very mild symptoms focal interstitial inflammation.
From benign tumors of the kidney are observed adenomas, fibroma, lipoma, fibroids, angiomas, teratoid tumors, handsome, osteomas, Mikami, neurofibromas, papillomas. They can be single or multiple, located in cork (adenoma) and brain (fibroma) layers, usually clear, thick consistency, color from yellow (adenoma) to dark red (hemangioma). Teratoid tumors P. separated into simple cystic education type a dermoid cyst (printing. Fig. 1), hamartomas, and embryonal tumors of mesenchymal origin. All benign tumor may recur after removal.
Malignant tumors of the kidney can be primary or secondary. From the primary most common gipernefroidnyi kidney cancer, then cancers that develop in the form of a whitish site without clear boundaries with yellow fields of necrosis. Histologically, they have the nature of solid cancer, adenocarcinoma (often Cisco-papillary or squamous cell cancer (orogovevshie or non-squamous), if the tumor originates from the pelvis. Sarcoma is rare, usually reaches a very large size, captures both cortical and brain layer, microscopically tumor often has a structure of fibrosarcoma. Mixed tumor - so-called embrionalnuju nephroma (see Wilms ' tumor) is common in children. Secondary tumors of the kidney arise by hematogenous, rarely lymphogenous metastasis. This is cancer, sarcoma, melanoma, chorionepithelioma. They can be in the form of multiple or single node, clearly distinguished from environmental parenchyma P. Leukemic infiltration of kidney tissue with leukaemia is only a manifestation of the common ailments of the body.
Parasites kidney rare. Echinococcus enters the kidneys hematogenous from the digestive tract, less frequently through the thoracic duct (lymphogenous). If Echinococcus cyst located in the cortical layer, grow slowly, reaching a very large size. Rare cysticerci, Schistosoma, filaria that usually localized in the mucosa of the pelvis and cups, causing a picture of chronic pyelonephritis.
Changes in the kidney under the influence of therapy. Mercosul, Marcelin, preparations of silver, gold, bismuth, chromic salts, infogruppa blood, antibiotics directly act on the fabric of the kidneys. Other drugs increase sensitisation of the kidneys, causing allergic changes its parenchyma. Excessive use of diuretic funds (type Mercosul and marsalina) causes the abrupt change in the epithelium of convoluted and direct channel from granular dystrophy up coagulation necrosis up to calcification of the dead mass of the epithelium. Prevalence of the process depends on the frequency of use of drugs and their dosages. The preparations of silver can lead to osteoarthritis P. however P. increased, with small dark spots in the crust and silver heart attacks in sobachko. Microscopically in the course of vascular loops clubockov and basal membrane tubules is determined narrow hem, consisting of black dots. Silver heart attacks are the deposition of boulders silver in the stroma of papillae. The use of drugs of gold may be complicated by krizisom - deposition in the stroma P. pigment from gray to bluish-violet, depending on the amount of pigment occur secondary phenomena violations of the circulation in the body. Bismuth, chromic salts, phosphorus, the drugs group choline called dystrophic processes in a convoluted tubule epithelium from fatty dystrophy it up to necrosis.
The frequency of toxic reactions when sulfa therapy in the first place is streptocide, then go sulfidina and norsulfazol. Predisposing moments are acidic reaction urine and reduced urine output. Defeat P. may be of two types. When one kidneys are enlarged, swollen, with pale yellow cortical layer. Microscopically - cloudy swelling convoluted tubule epithelium, fatty him until focal necrosis, in the tubules of the abundance of red blood cells, bleeding in the pelvis. Another kind of intoxication is manifested by a sharp expansion of the renal pelvis and ureters with filling their whitish crystals sulfidina, mixed with blood and amorphous mass that hinder the outflow of urine and for two-sided process which gives a picture of acute uraemia. The degree of changes P. depends on individual sensitivity of the organism to sulfa drugs. Changes under the influence of transfusion infogruppy blood give the classic picture nephrosis lower nephron.
Antibiotics penicillin may have a direct toxic effect on the kidneys, causing changes lizosom convoluted tubule epithelium. Last stick together with each other, forming blocks, with the release of mass hydrolytic enzymes, leading to necrosis of renal epithelium. Neomycin may also cause cloudy swelling, vacuolization and necrosis of epithelial convoluted tubule. Tetracycline has the ability to block redox enzymes convoluted tubule epithelium, suppressing reabsorbtion function of the proximal part of the nephron.
To drugs, causing changes kidney allergic nature, are amidopyrine, barbiturates, camphor, musk. With individual intolerance of these drugs in vessels P. develops picture fibrinoidnogo necrosis with perivascular infiltration by type of periarteritis nodosa with secondary necrosis and hemorrhage into the parenchyma. Ii. increase their surface is dark red, smooth, in the context of variegated fabric (yellow areas alternate with dark red), in the pelvis hemorrhage. It may exit acute uremia. Drugs camphor can cause widespread renal artery spasm, resulting massive necrosis in the kidneys.
If the pressure inside the pelvis (hydronephrosis, retrograde pyelography, hyperkinesia urinary tract) have so-called pelvic-kidney reflux (see), clinically expressed in hematuria. There are breaks vaults P. and penetration of urine in the kidney sinuses. P. thus increased, pale, sobachko foci of hemorrhage, within the kidney and renal blood. Microscopically in the discontinuities of the foci of hemorrhage and necrosis. Cm. also Nephritis, Nephrotic syndrome.

Kidney diseases