Introduction Primary neoplastic lesions of the kidney can be divided according to the age groups of affected patients. Renal tumors in children generally resemble the nephrogenic tissues of embryogenesis and include nephroblastoma (Wilms tumor) and clear cell sarcoma. Renal cell carcinomas (RCCs) are the major neoplasia of the kidney in adults. They have been classified on the basis of their histologic appearance, but studies have determined…

Introduction Polycystic kidney disease (PKD) is clinically and genetically heterogeneous and is the most common heritable kidney disease. PKD can be inherited either in a dominant or recessive pattern. Cystic kidney disease is a common feature of ciliopathies and is one of the most common causes of end-stage renal disease in both children and adults. Although single simple cysts of the kidney are relatively common and…

Introduction Evaluation of the renal morphology in allograft patients is used to answer two major questions: Is the failure of the graft caused by rejection or some other unrelated lesion? And if rejection is present, what immune mechanism(s) is (are) the cause, and is the lesion potentially reversible using available therapeutic approaches? In the absence of evidence of rejection, it should be ascertained whether the graft…

Introduction Chronic or end-stage kidney disease can result from widely divergent causes, such as glomerular, vascular, and tubulointerstitial diseases. The use of the formulaic estimated glomerular filtration rate (eGFR) is now a standard practice, and this has resulted in the identification of patients at risk for end-stage disease early in the disease course. A chronic kidney disease staging system based on eGFR is routinely applied. A…

Introduction Chronic kidney disease (CKD) is a worldwide public health problem affecting approximately 10% to 13% of the population in developed countries, where diabetes mellitus and hypertension are the leading causes of CKD. In developing countries, the percentage of patients with CKD not caused by diabetes or hypertension is considerably higher than in developed countries. The higher proportion of CKD in these countries could be the…

Introduction The tubulointerstitial compartment is affected in all forms of renal disease with changes that include tubular epithelial injury, atrophy, hypertrophy/hyperplasia, and fibrosis. These changes can be primary, with the tubule and interstitium as the target of damage, but they are often secondary to glomerular or vascular disease, where tubular atrophy and interstitial scarring accompany the primary glomerular or vascular disease. This chapter is focused on…

Diabetic nephropathy The classic patient with diabetic nephropathy (DN) typically presented with gradual progression of disease from microalbuminuria to proteinuria, usually about 15 years after onset of diabetes. Renal lesions are quite similar in type I and type II diabetes mellitus (DM), although the delay in clinical diagnosis of type II DM may give the appearance of shorter interval to DN in these patients. Patients with…

Primary glomerular diseases Glomerular diseases that cause nephrotic syndrome: Nonimmune complex Minimal change disease and focal segmental glomerulosclerosis: Introduction Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) both typically present as nephrotic syndrome and cannot be readily distinguished based solely on clinical presentation. Approximately 90% of children ages 1 to 7 years with nephrotic syndrome appear to have MCD, and the vast majority respond to…

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