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Left: acquired cystic disease; right: with renal cell carcinoma
Renal transplant 12 years prior
With central scar
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Mechanisms of donor specific ABMR
Contributed by Arzu Sağlam, M.D.
Active antibody mediated rejection
Contributed by Arzu Sağlam, M.D.
Peritubular capillaritis and glomerulitis
Peritubular capillaritis
Severe peritubullary capillaritis (ptc3)
Peritubullary capillaritis, neutrophils
Peritubullary capillaritis
Glomerulitis
Peritubullary capillaritis, JMS stain
Peritubullary capillaritis, PAS stain
Transplant glomerulopathy
Chronic active ABMR
Transplant glomerulopathy and glomerulitis
Transplant glomerulopathy
Chronic active ABMR, JMS stain
Transplant glomerulopathy, JMS stain
C4d staining, IHC
Contributed by Arzu Sağlam, M.D.
Chronic active TCMR, allograft nephrectomy
Contributed by Arzu Sağlam, M.D.
Interstitial inflammation
Interstitial inflammation - macrophage predominant
Tubulitis
Severe tubulitis
Tubulitis, PAS stain
Tubulitis, JMS stain
Intimal edema and lymphocyte margination
Interstitial hemorrhage
Intimal arteritis
Intimal arteritis, JMS stain
Transmural arteritis
Transmural arteritis and fibrinoid necrosis
Acute allograft glomerulopathy
Acute allograft glomerulopathy JMS stain
Severe acute allograft glomerulopathy
i-IFTA
Tubulitis of atrophic tubuli
Tubulitis of atrophic tubuli, JMS stain
Preserved renal parenchyma
Transplant arteriopathy
Transplant arteriopathy and IFTA, MTC stain
Intimal foam cells in small artery
Intimal foam cells and fibrosis in small artery, MTC
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Diagram of electron and light microscopy
Contributed by Aisha Memon, M.B.B.S.
Diffuse global proliferative appearance
Global proliferative appearance
Cellular crescent formation
Mesangial hypercellularity
Mesangial hypercellularity on periodic acid-Schiff
Contributed by Jonathan E. Zuckerman, M.D., Ph.D.
Endocapillary neutrophil
Subepithelial hump-like deposits
Mesangial deposits
Mesangial notch / hinge region deposit
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Subepithelial humps
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(a) CT: gas in
psoas muscle
(b) disappearance of
gas after treatment
CT: gas in renal parenchyma, and pararenal space
Ultrasound: "dirty" acoustic shadows (gas)
CT: gas in kidney and IVC
Contributed by Jian-Hua Qiao, M.D.
Bisected kidney
Detached renal capsule
Close view
Gas filled cysts
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Areas of papillary necrosis
Contributed by Jian-Hua Qiao, M.D.
Acute inflammation
Neutrophil casts
Abscess
Necrotic renal cortex
Gas filled cysts
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Inflammation and different stages of AKI
Pathophysiology of hypoperfusion related AKI
Contributed by Dale Davis, M.D., M.A.
Attenuated tubules with casts
Cell sloughing
Cytoplasmic blebbing
Loss of brush border
Frank necrosis
Contributed by Colleen Ford
Lumen with cellular debris
Aberration of basement membrane
Overview of intrarenal acute kidney injury
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Various images
Adenovirus immunoperoxidase stain
Contributed by Alexei Mikhailov, M.D., Ph.D.
Early Alport syndrome
Early chronic changes
Focal segmental glomerular scarring
Foam cells, Alport syndrome
Contributed by Alexei Mikhailov, M.D., Ph.D.
Microvillus transformation
Characteristic changes
More advanced changes
Thin basement membrane disease
Alport-like changes
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Various images
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Vertical section
Normal glomerulus
Vessels surrounding glomeruli and tubules
Relation to other organs
Juxtaglomerular apparatus
Renal column
Vessels supplying tubule
Vessels surrounding glomeruli and tubules
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Fetal kidneys at 25 weeks gestation
Infant kidney with fetal lobulations
Normal adult kidney
Contributed by Grigory Demyashkin, M.D., Ph.D.
6 - 8 week embryo:
Metanephros; adrenal gland medulla
Metanephros; colon; pancreas
Small intestine; stomach;
gonad and kidney primary
(mesonephros); symphysis
Final kidney (metanephros), renal corpuscle
Final kidney (metanephros), renal corpuscle, collecting ducts
Metanephros; adrenal gland medulla
Final kidney (metanephros)
Final kidney (metanephros);
liver; gonad & kidney
primary (mesonephros);
symphysis
Final kidney (metanephros)
Adrenal gland, medulla & final kidney (metanephros)
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Glomerular capillary loops are thin and delicate
Basement membranes
of glomerular
capillary loops and
tubular epithelium
Collecting duct: brush border
Juxtaglomerular apparatus and macula densa
Medullary rays
Contributed by Alexander J. Gallan, M.D.
Tubular injury
Contributed by Alexander J. Gallan, M.D.
TBM deposits
Segmental glomerular subepithelial deposits
Contributed by Ana Belén Larqué, M.D., Ph.D.
Cellular crescents
Fibrinoid necrosis
Disruption of Bowman capsule
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Extracapillary crescent
GBM, Alport and anti-GBM
Contributed by Husam Jum’ah, M.D.
Renal cortical surface with granularity
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Characteristic granular appearance
Contributed by Santhi Ganesan, M.D.
Global
glomerulosclerosis
Arterial medial thickening
Hyaline vascular changes
Obsolescent glomerulus
Global
glomerulosclerosis
PAS
Subintimal fibrosis trichrome
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Angiogram
Contributed by Debra L. Zynger, M.D.
Numerous cysts of varying sizes
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Enlarged kidney with variably sized cysts
With transplanted kidney
Compared to normal kidney
Hemorrhagic infarct with rupture
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Cysts of varying sizes; glomerular cyst present at birth (rare)
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Markedly enlarged kidneys
Enlarged kidneys with persistent fetal lobation
Uniform distribution of small cysts
Small cysts in cortex and medulla
Renal surface shows small cysts
Spongy cut surface
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Radial arrangement of cysts with only rare glomeruli
Dilated collecting ducts in cortex and medulla
Immunostains
Associated congenital hepatic fibrosis
Contributed by Vanderlene Liu Kung, M.D., Ph.D.
Glomerular capillary luminal neutrophils
Diabetic
glomerulosclerosis
with exudative GN
Cellular crescent
Contributed by Vanderlene Liu Kung, M.D., Ph.D.
Intramembranous / subepithelial deposits
Contributed by Deepak K. Pruthi, M.D., M.Sci.-T.S.
CT abdomen
Contrast enhanced
Axial CT
Coronal CT
Postsclerotherapy
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Simple cyst of upper pole
Large cyst
Multiple, smooth renal cysts filled with serous fluid
Solitary, smooth
kidney cyst
(lower pole) filled
with serous fluid
Large cortical cysts with dark red blood
Contributed by Rana Chakrabarti, M.D., M.P.H.
Subcapsular cortical cyst
Flattened cyst wall epithelium
Papillary excrescence
Contributed by Jonathan E. Zuckerman, M.D., Ph.D.
Bile stained kidney
Contributed by Jonathan E. Zuckerman, M.D., Ph.D.
Bile casts in collecting ducts
Bile casts in proximal tubules
Hall bile stain
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Bile case
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Dividing up core tissue
if no dissecting
microscope is present
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A: renal cortex with
round red glomeruli;
B: renal medulla
without glomeruli
Contributed by Arzu Sağlam, M.D.
Well demarcated inflammation
Tubulitis and intranuclear inclusions
Polyomavirus score: pvl 3
Luminal casts and cytopathic changes
Cytopathic changes
Intranuclear basophilic granules
Glomerular cytopathy
Anti-SV40 antibody, IHC
Contributed by Çisel Aydιn Meriçöz, M.D.
Decoy cells in urine cytology
Contributed by Jonathan E. Zuckerman, M.D., Ph.D.
Viral particles
Nuclear viral particles
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Polyomavirus Haufen
Polyomavirus Haufen and CISH staining
Tubular basement membrane deposits
Histomorphological characteristics of BK virus associated nephropathy in a transplant patient
by Dr. Arzu Sağlam
Contributed by Ana Belén Larqué, M.D., Ph.D.
Glomeruli with membranoproliferative pattern
Glomerulus with mesangial pattern
Glomerular basement membrane thickening
Double contour capillary walls
Contributed by Ana Belén Larqué, M.D., Ph.D.
Linear electron dense deposits
Membranoproliferative GN
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Various images
Allograft treated with cyclosporine A
Classic features of
calcineurin inhibitor
toxicity (cyclosporine
and tacrolimus)
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Recommendations
for management
Mechanisms of immune checkpoint blockade
Treatment, recovery, rechallenge, recurrence rates
Contributed by Vincenzo L’Imperio, M.D. and Giorgio Cazzaniga, M.D.
Neutrophilic tubulitis
Interstitial inflammatory infiltrate
Tubulitis
Plasma cell rich infiltrate
Neutrophil rich infiltrate
Contributed by Vincenzo L’Imperio, M.D. and Giorgio Cazzaniga, M.D.
Tubulitis
Contributed by Alexei Mikhailov, M.D., Ph.D.
IFTA with lymphocytic inflammation
Glomerulus in CKDu
Ischemic glomerulus in CKDu
Glomerular obsolescence in MeN
MeN interstitial inflammatory infiltrate
Perihilar FSGS in CKDu
Contributed by Alexei Mikhailov, M.D., Ph.D.
MeN glomerular capillary
MeN podocyte effacement
Contributed by Saman Karimi, M.D., M.S., Suman Setty, M.B.B.S., Ph.D. and Vijay Shankar, M.D.
Schematic of chronic pyelonephritis
Contributed by Saman Karimi, M.D., M.S. and Suman Setty, M.B.B.S., Ph.D.
Interstitial chronic
inflammation,
tubular atrophy
and fibrosis
Interstitial chronic
inflammation and
periglomerular fibrosis
Renal tubular atrophy with luminal casts
Dense interstitial fibrosis
Overview of chronic pyelonephritis
Histological features of chronic pyelonephritis
Contributed by Joseph Grande, M.D., Ph.D.
Lobular mesangial expansion
Silver negative material deposits
PAS weak / negative deposits
Trichrome stains deposits blue
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Enlarged glomerulus with hyaline cap deposits
Lobular appearance
With Hodgkin's lymphoma
Silver stain
Congo red stain
Contributed by Joseph Grande, M.D., Ph.D.
Extensive mesangial deposits
Higher power of subendothelial deposit
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Abundant subendothelial deposits of large fibers
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Renal hypoplasia
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Agenesis - bilateral
Incomplete duplication
Horseshoe kidney
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Oligomeganephronic renal hypoplasia
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Normal glomerular capillary and capillary wall
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Enlarged and hyperechogenic kidneys by ultrasound
Contributed by Chunlai Zuo, M.D., M.S.
Enlarged pale kidney
Contributed by Chunlai Zuo, M.D., M.S. and Jonathan E. Zuckerman, M.D., Ph.D.
Mesangial hypercellularity
Segmental glomerulosclerosis
Dilated proximal and distal tubes
Cystic change and interstitial fibrosis
Contributed by Jonathan E. Zuckerman, M.D., Ph.D.
Diffuse foot processes effacement
Loss of slit diaphrams
Mesangial hypercellularity
Endothelial cell blebs
Contributed by Shreeram Akilesh, M.D., Ph.D.
Acute tubular injury
Collapsing glomerulopathy
Collapsing glomerulopathy and TMA
Contributed by Shreeram Akilesh, M.D., Ph.D.
Podocyte foot process effacement
Effacement and TMA
Contributed by Khaled A. Murshed, M.D., Noheir M. Taha, M.B.B.Ch., M.D. and Mohammed Akhtar, M.D.
Cellular crescent
Cellular crescent high magnification
Fibrin and PEC proliferation
Cellular crescent with fibrin
Fibrinoid necrosis
Capillary wall defect high magnification
Bowman capsule defect
Circular crescent
Monolayer PEC proliferation
Early crescent
Fibrocellular crescent
Fibrocellular fibrous crescent
Fibrous crescent
Anti-GBM disease
ANCA associated GN
Contributed by Khaled A. Murshed, M.D., Noheir M. Taha, M.B.B.Ch., M.D. and Mohammed Akhtar, M.D.
Electron dense deposits
Pauci-immune
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Cryoglobulin related glomerulonephritis
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Various images
Contributed by Khaled A. Murshed, M.D., Noheir M. Taha, M.B.B.Ch., M.D. and Mohammed Akhtar, M.D.
Afferent and efferent hyalinosis, PAS
Capsular drop
Diffuse and nodular mesangial expansion
Diffuse mesangial expansion, PAS
Lipohyaline cap
Lipohyaline cap, PAS
Lipohyaline caps and nodules, PAS
Lipohyaline caps and nodules, silver
Microaneurysm, PAS
Microaneurysm, silver
Microaneurysm with nodule, silver
Microaneurysm with large nodule, silver
Nodular lesions, PAS
Nodular lesions, PAS
Segmental sclerosis
Thickening of Bowman capsule
Thickening of basement membrane
2 insudative lesions
Vascular hyalinosis
Contributed by Khaled A. Murshed, M.D., Noheir M. Taha, M.B.B.Ch., M.D. and Mohammed Akhtar, M.D.
Low magnification
Mesangium and glomerular basement membrane
Thickening of glomerular basement membrane
Diabetic nephropathy
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Various images
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Extensive focal cortical necrosis
with tubular necrosis and fibrin
thrombi in the glomerulus
Necrotic areas having ghost
outlines of glomeruli and tubules
with loss of cellular details
Histopathology kidney: diffuse cortical necrosis
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Mesangial sclerosis
WT1 associated
Contributed by Nicole K. Andeen, M.D.
Case 1:
Normal glomerulus (FS)
Normal glomerulus
and adjacent intact
tubular parenchyma (FS)
Focal global GS in
subcapsular region
(H&E perm from FS)
Patches of tubular atrophy
& associated nonspecific
interstitial inflammation
(H&E perm from FS)
Low power with
no global GS (FS)
Low power with focal global GS
predominantly in subcapsular
region and patchy tubular atrophy
and IF (H&E perm from FS)
Case 2:
Focal global GS, ischemic glomeruli
with periglomerular fibrosis, adjacent
tubular atrophy, IF and nonspecific
interstitial inflammatory infiltrate (FS)
Focal global GS, adjacent
tubular atrophy and IF (FS)
Focal global and focal
and segmental GS, tubular
atrophy and IF (perm,
Jones silver stain)
Focal segmental GS, adjacent
arteriolar hyalinosis, tubular atrophy
and IF (perm, Jones silver stain)
Note: FS = frozen section, GS = glomerulosclerosis, IF = interstitial fibrosis, perm = permanent section
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Multicystic renal dysplasia
Multicystic renal dysplasia
Unilateral renal agenesis
Contributed by Robyn C. Reed, M.D., Ph.D.
Distorted shape, numerous cysts
Cysts, minimal remnant parenchyma
Hypoplastic kidneys at autopsy
Bilateral agenesis in situ
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Multiple cysts of various sizes
Multiple cysts of various sizes
With small bladder
Cysts are smooth
lined, no normal
kidney tissue
is apparent
With ipsilateral hypoplasia of ureter
Due to congenital urethral stenosis
Contributed by Robyn C. Reed, M.D., Ph.D.
Cysts in dysplasia
Cysts and primitive tubules
Tubule with mesenchymal collarette
Metaplastic cartilage
Cartilage and blastemal tissue
Primitive tubules
Development of renal dysplasia
Development of renal agenesis; explanation of oligohydramnios sequence
Contributed by Nicole K. Andeen, M.D.
Crescent
Arteritis
Medullary angiitis
Contributed by Nicole K. Andeen, M.D.
Fibrin tactoids
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Various images including EM
Global sclerosis,
segmental sclerosis
with moderate
interstitial fibrosis
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inclusion bodies in
cytoplasm of skin
fibroblasts
Contributed by Mandolin S. Ziadie, M.D. and Nicole K. Andeen, M.D.
Thick glomerular basement membrane and expanded mesangium
Jones methenamine silver
Trichrome
Periodic Acid-Schiff
DNAJB9
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Mesangial expansion
and glomerular
basement membrane
thickening
Variable glomerular findings
Contributed by Mandolin S. Ziadie, M.D.
Glomerular basement
membrane and
mesangial expansion
Randomly arranged fibrils
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Fibrillary deposits in mesangium
Randomly arranged fibrils
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Eosinophilic material in mesangial regions
Immunoelectron microscopy with anti-fibronectin
Glomeruli show massive deposits of a homogeneous structureless
Massive flooding of the glomerulus with fibronectin
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Enlargement of glomerular basement membrane and massive mesangial electron-dense deposits
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Primary and secondary FSGS
Sclerosis development in FSGS
Contributed by Vincenzo L’Imperio, M.D. and Giorgio Cazzaniga, M.D.
Segmental sclerosis with adhesion
Segmental sclerosis at the tubular pole
Segmental sclerosis with collapse
Perihilar segmental sclerosis with hyalinosis
Contributed by Vincenzo L’Imperio, M.D. and Giorgio Cazzaniga, M.D.
Complete foot process effacement
Foot process effacement and microvillous transformation
GBM lamellation
Contributed by Nicole K. Andeen, M.D.
Collapse of the glomerular tuft and prominence of the overlying epithelial cells, Jones stain
PAS
Trichrome
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Collapsed glomerulus
With sickle cell disease
Various images
Contributed by Nicole K. Andeen, M.D.
Podocyte foot process effacement
Contributed by Anjali A. Satoskar, M.D.
Segmental necrotizing lesion
Red blood cell (RBC) casts
Global necrotizing lesion
Global necrotizing lesion
Global necrotizing
lesion with
destroyed
Bowman capsule
Giant cells
Karyorrhectic nuclear debris
Necrotizing vasculitis
Fibrocellular crescent
Fibrous crescent
Contributed by Anjali A. Satoskar, M.D.
Fibrin strands on ultrastructural examination
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Various images
Contributed by Dalia Y. Ibrahim, M.D., M.Sc.
Bloodless glomerulus
Glomerulus with fibrin thrombi
Mucoid intimal thickening
Occluded artery with thrombus
Artery with thrombus and fragmented red blood cells
Occluded artery with thrombus, Trichrome stain
Contributed by Dalia Y. Ibrahim, M.D., M.Sc.
Subendothelial widening, ultrastructural examination
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Etiologies of TMA
Diagnostic algorithm for TMA
Contributed by Evelyn T. Bruner, M.D.
Prominent fibrin thrombi
Glomerulus with prominent fibrin thrombi
Glomerulus with endothelial swelling
Glomerulus with prominent fibrin thrombi
Artery with mucoid intimal thickening
Glomeruli with prominent fibrin thrombi
Contributed by Dr. Avinash Mane (Case #403)
Numerous schistocytes and nucleated RBCs with extremely low platelets on peripheral smear
Contributed by Evelyn T. Bruner, M.D.
Endothelial swelling and lucency
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Various images
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Mechanisms of HIV associated renal disease
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Ultrasound features of HIVAN
Contributed by Vincenzo L’Imperio, M.D. and Giorgio Cazzaniga, M.D.
Collapsed glomeruli
Proliferative
glomerulonephritis
Tubular microcysts with sclerosed glomerulus
Tubular microcysts
Contributed by Vincenzo L’Imperio, M.D. and Giorgio Cazzaniga, M.D.
Tubuloreticular inclusion / aggregate (TRI)
Mesangial deposits
Subendothelial deposits
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Cortex is blue, edematous and congested
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Various images
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Idiopathic nodular glomerulosclerosis
Contributed by Maria Fernanda Soares, M.D., Ph.D.
M1 lesion, PAS
E1 lesion
S1p lesion, PAS
Crescent, PAS
Red cell casts
Acute arterial TMA
Mesangial IgA
CD68 and E1 lesion
Contributed by Arkana
Mesangial expansion and loop adhesion, Jones silver
Mesangial expansion and global sclerosis, PAS
Mesangial expansion and loop adhesion, PAS
Contributed by Maria Fernanda Soares, M.D., Ph.D.
Mesangial deposits
Mesangial and paramesangial deposits
Contributed by Arkana
Mesangial deposits
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Renal mass
PET positive mass
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White renal mass
Contributed by Jonathan E. Zuckerman, M.D., Ph.D.
Tubulointerstitial effacement
Storiform fibrosis
Plasmacytic inflammation
Storiform fibrosis
Increased plasma cells
IgG plasma cells
IgG4 plasma cells
Plasma cells and eosinophils
Contributed by Jonathan E. Zuckerman, M.D., Ph.D.
Tubular basement membrane deposits
Subepithelial deposits
Mesangial deposits
Bowman capsule deposits
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Various images including EM
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Figures e - h
With fibrillary glomerulonephritis
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Biopsy findings
Crystal induced tubular injury
Indinavir crystals in urinary sediment
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Granulomatous giant
cell reaction with
crystals within lumen
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Wedge shaped hemorrhagic infarcts
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Various images
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Pathophysiology of cast nephropathy
Contributed by Ramya Krishna Velagapudi, M.D., M.H.A.
Pale appearance of casts, PAS
Fractured appearance of casts, PAS
Pale casts with giant cell reaction
Syncytial giant cell reaction
Metachromatic casts, trichrome stain
Crystalline appearance of casts
Contributed by Ramya Krishna Velagapudi, M.D., M.H.A.
Intratubular cast
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Intraluminal cast
Granular cast
Crystalline appearance of casts
Washington University in St. Louis: renal pathology teaching series
Contributed by NephroPath
Light chain deposits along GBM
sclerosis and
tubular injury
on silver stain
Mesangial nodular sclerosis on PAS
Mesangial nodular sclerosis on silver stain
Mesangial nodular sclerosis on trichrome stain
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Various images
Contributed by NephroPath
Light chain deposits along GBM
Light chain deposits along TBM
Contributed by Rajib K. Gupta, M.D.
LCPT, crystalline variant
LCPT, noncrystalline variant
Contributed by Rajib K. Gupta, M.D., Ashley Flowers, M.D. and Judy King, M.D., Ph.D.
Acute tubular injury / necrosis in LCPT
Crystals within proximal tubular epithelium
Fuchsinophilic crystals within proximal tubular epithelium
Noncrystalline variant of LCPT
Contributed by Rajib K. Gupta, M.D., Judy King, M.D., Ph.D., Ashley Flowers, M.D. and Xin Gu, M.D.
Intracytoplasmic crystals, crystalline variant of LCPT
Abnormal lysosomes, noncrystalline LCPT
Abnormal lysosomes with mottling, noncrystalline LCPT
Abnormal mitochondria, noncrystalline LCPT
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Yellowish rubbery solid mass
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Michaelis-Gutmann bodies, high mag
Expansion of the interstitium
von Kossa stain
Infiltration of sheets
Histiocytes
CD68+
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Tongue mass
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Various images
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Various images
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Cysts of inner medullary and papillary region
Extensive cysts communicating with each other
Papillae are interspersed due to variably sized cysts
Small cysts with stones, papillae on right is not affected
Numerous medullary cysts and isolated cortical cyst
Cysts at corticomedullary junction
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Cysts in papilla
With microlithiasis and chronic pyelonephritis
Cortical cyst, multiple cysts
at the corticomedullary
junction and atypically
located papillary cyst
Contributed by Ana Belén Larqué, M.D., Ph.D.
Glomerular basement membrane thickened
Subepithelial spikes
Granular staining for IgG4
Granular staining for PLA2R
Contributed by Ana Belén Larqué, M.D., Ph.D. and Jonathan E. Zuckerman, M.D., Ph.D.
Subepithelial deposits
Intramembranous deposits
Membranous nephropathy, stage I
Membranous nephropathy, stage II
Membranous nephropathy, stage III
Membranous nephropathy, stage IV
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Intramembranous deposits
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Lipoid nephrosis
Contributed by Ana Belén Larqué, M.D., Ph.D.
Normal glomerulus
Normal glomerulus and interstitium
Tubules with hyaline droplets
Aggregates of lipid laden macrophages
Contributed by Ana Belén Larqué, M.D., Ph.D. and Nicole K. Andeen, M.D.
Foot process effacement
Hypertrophic podocytes
Diffuse podocyte foot process effacement
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Foot process effacement
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Common MGRS nephron lesions
Contributed by Rajib K. Gupta, M.D., Ashley Flowers, M.D. and Lois J. Arend, M.D., Ph.D.
Nodular expansion of mesangium, AL amyloid
Congo red under polarized light, AL amyloid
Mesangial matrix expansion (nonnodular), FGN
Membrano-proliferative pattern, ITGN
Nodular mesangial matrix expansion, LCDD (MIDD)
Membrano-proliferative pattern, PGNMID
Membrano-proliferative pattern, C3G (C3GN)
Membrano-proliferative pattern in type 1 CryoGN
Crystalglobulin induced nephropathy
Mesangiolysis in TMA with monoclonal gammopathy
Proximal tubules in LCPT, crystalline pattern
Tubules in MIDD
Contributed by Rajib K. Gupta, M.D., Ashley Flowers, M.D., Judy King, M.D., Ph.D. and Xin Gu, M.D.
Pale mesangial expansion due to amyloid fibrils
Mesangial expansion by slightly thicker fibrils, FGN
Microtubular deposits, ITGN
Powdery deposits, LCDD / MIDD
Glomerular deposits, C3-G (C3GN variant)
Microtubular deposits, type 1 CryoGN
Crystals, crystalline type LCPT
Abnormal lysosomes, noncrystalline LCPT
Electron dense deposits, PGNMID
Occlusive crystalline deposits, CIN
Contributed by Haiyan Zhang, M.D., Ph.D.
GBM double contours
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Various images
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Cysts at corticomedullary
junction, tubular cysts
and interstitial infiltrate
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Tubules with thickened basal membrane (PAS)
Dilated tubules, thickened basal membrane (PAS)
Deformed tubules
with thickened basal
membrane in fibrotic
stroma (PAS)
Dilated tubules with lymphocytic infiltrate (PAS)
End stage renal disease:
Preserved glomeruli with individual glomerular cysts, tubulointerstitial fibrosis, hypertrophic tubules, lymphocytic infiltrate
Tubulointerstitial
fibrosis, tubular cysts
and lymphocytic
infiltrate (PAS)
Extensive obliteration of glomeruli
and sclerotic glomerli, interstitial
fibrosis, atrophic tubules and
chronic inflammation (PAS)
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Tubules:
Thickened tubular basement membrane
Grid-like
degeneration of
tubular basement
membrane
Atrophic tubules
with partly thickened,
partly missing
basal lamina
Basal membrane shows
thickening, splitting,
grid-like degeneration
or complete absence
Collapsed glomeruli
centrally, Bowman
capsule is filled with
amorphous material
Partially atrophic tubule with thickened basal membrane
Newly formed lamellar basal membrane
Cyst wall lined
with collecting duct
epithelium, basal
membrane is lost
Glomeruli:
Thickened glomerular
basal membrane with
lacuna, periglomerular
fibrosis
Mild periglomerular fibrosis,
thickened tubules with
fragmented basal lamina,
lymphocytes
Contributed by Jonathan E. Zuckerman, M.D., Ph.D.
Glomerulomegaly
Perihilar focal segmental glomerulosclerosis
Glomerulomegaly
Glomerulomegaly, tubular hypertrophy
Perihilar focal segmental glomerulosclerosis
Normal glomerulus
Contributed by Jonathan E. Zuckerman, M.D., Ph.D.
Mild GBM thickening
Segmental foot process effacement
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Various images
Contributed by Jonathan E. Zuckerman, M.D., Ph.D.
Type 1 primary hyperoxaluria
Secondary oxalosis: calcium phosphate deposition
Secondary oxalosis: intraluminal calcium phosphate deposition
Fan shaped calcium oxalate deposits
Contributed by Jonathan E. Zuckerman, M.D., Ph.D.
Oxalate crystals
Contributed by Ana Belén Larqué, M.D, Ph.D.
Arterial wall with fibrinoid necrosis
Cellular crescent
Crescents
Segmental fibrinoid necrosis of glomerular tufts
Interstitial inflammation
Case #34 - HacettepePathology
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Pale amyloid deposits in enlarged kidney
Contributed by Anthony Sisk, D.O.
Glomerulus
PAS, glomerulus
Jones silver, glomerulus
Trichrome, glomerulus
PAS, tubulointerstitium
Congo red
Polarization of Congo red
Amyloid A stain
Contributed by Anthony Sisk, D.O.
Glomerular involvement
Fibril measurements
Spicule formation
Contributed by Saskia von Stillfried, M.D.
Normal glomerulus
Thick appearance of GBM
Mesangial hypercellularity
Membrano-proliferative glomerulonephritis
Focal segmental
glomerulosclerosis
Nodular glomerulosclerosis
Global glomerulosclerosis
Cellular crescent
Normal tubuli
Acute tubular injury
Interstitial fibrosis and tubular atrophy
Interstitial inflammation
Contributed by Mazdak Khalighi, M.D. and Nicole K. Andeen, M.D.
Acute tubular injury with pigmented, granular and focally stringy appearing casts
PAS
Myoglobin
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Various images
Granulomatous interstitial nephritis
nonspecific features,
which is common
Recurrence after renal transplant
Contributed by Christine M. Lee, M.D. and Jonathan E. Zuckerman, M.D., Ph.D.
Onion skin change
Onion skin change in artery
Mucoid intimal edema
Double contours
Contributed by Christine M. Lee, M.D. and Jonathan E. Zuckerman, M.D., Ph.D.
Double contour
Artery remodeling
Contributed by Nicole K. Andeen, M.D.
Plasma cell rich tubulointerstitial nephritis (Jones stain)
Mesangial IgA deposition
Contributed by Nicole K. Andeen, M.D.
Mononuclear inflammatory infiltrate
Contributed by Jian-Hua Qiao, M.D.
Various images
Contributed by Jian-Hua Qiao, M.D.
Renal artery dissection
Renal cortex ischemic infarction
Renal papillae hemorrhagic infarction
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Ultrastructural features
of a single glomerular
capillary affected by
lupus nephritis
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Diffuse proliferative lupus nephritis
Contributed by Alexei Mikhailov, M.D., Ph.D.
LN II: segmental mesangial hypercellularity
LN III: segmental fibrinoid necrosis
LN III: segment with karyorrhexis
LN IV: renal vasculitis
LN IV: endocapillary hypercellularity
LN IV: wire loops, hyaline thrombi
LN IV: vasculopathy
LN IV: torn capillaries
LN V: membranous alterations
LN V: microspikes
Contributed by Alexei Mikhailov, M.D., Ph.D.
LN IV: immune deposits
LN IV: tubuloreticular inclusions
LN IV: organized deposits
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Pathogenesis
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ECG gated double inversion recovery
Fast gradient echo
MR angiography
Contributed by Nicole K. Andeen, M.D.
White lesion
Contributed by Nicole K. Andeen, M.D.
Active vasculitis with giant cells
Tubulointerstitial inflammation
Jones
Elastic
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Diagram of Tamm-Horsfall protein secretion (green dots), forming a hyaline cast in the collecting duct
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Nephronophthisis: end stage renal disease
Lymphatics
Pyelonephritis - protein cylinder
Pyelonephritis immunostain
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In lymphatics
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Various images
no abnormalities
on H&E
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Diagnosis of
inherited interstitial
kidney disease
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Drug induced tubulointerstitial nephritis
Contributed by Sam T. Albadri, M.B.Ch.B., M.Sc.
Interstitial inflammation
Tubulitis
Granulomatous interstitial nephritis
Eosinophilic tubulitis
IgG4 related kidney disease
IgG
IgG4 immunostain
Contributed by Sam T. Albadri, M.B.Ch.B., M.Sc.
Interstitial inflammation and tubulitis
Histopathology kidney - interstitial nephritis
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Chronic urate nephropathy
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Gouty nephropathy
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Passage of a calculus (stone)
Contributed by Jian-Hua Qiao, M.D.
Multiple kidney stones
Contributed by Alexandra Barabasch, M.D.
Renal parenchyma on CT
Dilated renal pelvis on CT
Contributed by Saskia von Stillfried, M.D.
Macroscopic appearance
Contributed by Saskia von Stillfried, M.D.
Zonal structure
Middle zone
Xanthoma cells
Touton giant cell
Cholesterol clefts
CD68+ macrophages (xanthoma cells)
Pankeratin positive tubuli and negative macrophages
Chang: 2018
D'Agati: 2005
Fatima: 2019
Husain: 2021
Jennette: 2015
Jiang: 2023
Satoskar: 2017
Scorecki: 2015
Zhou: 2017
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