Renal diseases. Glomerulopathy icon

Renal diseases. Glomerulopathy

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Renal diseases. Glomerulopathy.

Theme urgency: Illnesses of kidneys represent various and numerous group of diseases, both independent, and secondary. Glomerulopathies are the diseases of kidneys connected with primary defeat glomerular device and infringement glomerular filtration. Them concern glomerulonephritis, idiopathic nephrotic syndrome or glomerulonephritis with the minimum changes, amyloidosis of kidneys, diabetic or hepatic glomerulosclerosis. Knowledge and the abilities received on employment helps understanding of essence, the reasons, mechanisms of development, morphological displays of these diseases and it is necessary for the doctor for understanding of clinical displays, their timely diagnostics, appointment of adequate pathogenetic therapy and preventive maintenance of possible complications.

The purpose (general): to be able to analyze and distinguish from other diseases of kidneys on the basis of morphological characteristics the most important diseases of kidneys with primary defeat glomerular device (glomerulonephrites, idiopathic nephrotic syndrome, amyloidosis of kidneys) to distinguish them on a morphologic picture to estimate their value for an organism and an outcome.

^ Specific goals: Purpose of initial level

To be able

1. To distinguish morphological signs of illnesses of kidneys with primary defeat glomerular device, considering an etiology and illnesses pathogenesis.

1. To distinguish and interpret normal structure (Anatomy), histologic structure (Histology), function (Physiology) of kidneys.

2. To diagnose, interpret, represent morphological essence on macro-and a microscopic picture postinfectios, quickly progressing, chronic glomerulonephritis, idiopathic nephrotic syndrome and amyloidosis of kidneys.

2. To distinguish and interpret microscopic signs (including eleсtron microscopy signs of cells nephron and basal membranes), mesangial, epithelial and endothelial cells of glomerular device of a kidney and a histologic picture of tubule -interstitial device of kidneys (Histology).

3. To distinguish on the basis of macro- and microscopic researches of changes in glomerular, tubules, stroma at glomerulonephrites, idiopathic nephrotic syndrome and amyloidosis of kidneys, to estimate value of these changes in development of disease and consequences for an organism.

3. To distinguish and estimate different ways of coloring of structures of tissue and kidney cells (Histology).

That you could understand, whether there corresponds initial level of your knowledge-abilities necessary, suggest to execute a number of tasks.

Tasks for self-examination and self-checking of initial level of knowledge-abilities.

Test 1. At opening of a corpse of a kidney have бобовидную form in the size 10х4.5х4 sm, weight 120 gram. A surface of kidneys smooth, on a cut border cortical and brain substance clear, drawing accurate. A tissue on a cut of grey-pink color. The description, what kidney is resulted in the opening report?

1. A normal kidney.

2. A kidney with congenital developmental anomaly cortical substances.

3. Pathologically changed kidney.

4. A kidney with congenital developmental anomaly of brain substance.

5. A kidney with the got developmental anomaly.

Test 2. At the patient with developmental anomaly of kidneys at electron microscopy research it is established, that nephrons consist from vascular glomeruli. What else structures are a part nephron?

1. An external and internal leaf of Bowman capsule.

2. Извитые канальцы 1st and 2nd order.

3. Genle loop.

4. Collective tubules.

5. All answers are true.

Test 3. At immunofluorescence microscopy presence of immune complexes on basal membrane glomelular filter more close to endothelial capillaries is defined. What else structures are a part of glomelular filter?

1. Epithelium of Bowman’s capsules.

2. Mesangial cells.

3. Epithelial cells of distal channel.

4. A complex of mucopolisacharids, big and small shoots of podocyts.

5. Epithelial cells of proximal channel.

Test 4. At inspection of the patient it is established, that at it processes of a filtration of urine are broken. What structural divisions of nephron are responsible for function of a filtration of urine?

1. Proximal channel.

2. Vascular glomeluli of kidneys.

3. Distal channel.

4. Juxtamedullar zone.

5. Genle Loop.

Standards of answers to the decision of tasks for self-examination and self-checking of initial level of knowledge-abilities: 1-1, 2-5, 3-4, 4-2.

The information necessary for replenishment of knowledge-abilities can be found in following references:

1. Prives M.G.,Lysenko M.K. //Human anatomy. - М, Medicine, 1985. - S.322-332.

2. Yeliseyev V. G, Afanasev J.I., Yurin I.O. //Histology. - М, Medicine, 1983.-S.530-541.

3. Hem A, Kormak D.//Histology. - М, World, 1983. т.2, S.56-106.,


4. Kositsky M.I. //Physiology. - М, Medicine, 1985.-S.311-317.

The basic theoretical questions on which basis performance of target kinds of activity is possible.

1. Essence and modern clinical-morphologic classification of illnesses of kidneys. The characteristic of clinical syndromes at diseases of kidneys.

2. Essence of glomerulonephrites: an etiology, pathogenesis, classification on pathogenesis, to character of morphological changes in glomelular and to a current.

3. The essence and morphology postinfectios (sharp) glomerulonephritis, it is also a microscopic picture, outcomes and an estimation of value for an organism.

4. Essence and morphology quickly progressing (malignant flowing) glomerulonephritis: an etiology, pathogenesis, macro-and a microscopic picture, outcomes, value for an organism.

5. Essence and morphology of clinical-morphologic forms of chronic glomerulonephritis, features of a current, value.

6. Essence and morphology of changes in a myocardium at quickly progressing and chronic glomerulonephrites, complications, outcomes, causes of death.

7. Essence and morphology idiopathic nephrotic syndrome (glomerulonephritis with the minimum changes): cause developments, pathogenesis, morphology, outcomes.

8. Essence and morphology amyloidosis of kidneys: cause developments, pathogenesis, macro-and a microscopic picture, complications, outcomes, causes of death.

The literature for mastering of necessary knowledge-abilities on the given theme:

1. Strukov A.I., Serov V.V. //Pathological anatomy. - М, Medicine, 1995. - S.399-409, 417-418.

2. Chair lectures on a theme: «Illnesses of kidneys. Glomerulopathy».

3. Pathological anatomy. A course of lectures. Under the editorship of V.V. Serova, M.A.Paltseva., М, Medicine, 1998. - S.451-464.

4. The count of logical structure that «Illnesses of kidneys. Glomerulopathy» (exhibit 1).

5. Algorithm of morphological diagnostics of diseases of kidneys (exhibit 2).

6. The studying instruction macro-and micropreparations (exhibit 1, 2, «Parenchimatosis dystrophies»).

The additional literature:

Serov V.V., Jarygin N.E., Paukov V.S. //Pathological anatomy. The atlas. - М, Medicine, 1986. – p.301-313.

After performance listed above tasks for self-examination of mastering of a material on the given theme it is offered to carry out following target tasks.

The task 1. At the child of 5 years has developed nephrotic syndrome, at research biopsy of kidneys, microscopic any changes it is not revealed, and at electron microscopy research - merge of small shoots of podocytes. What disease took place at the child?

1. Glomerulonephrities with the minimum changes (idiopathic nephrotic syndrome).

2. Postinfectios glomerulonephritis.

3. Membranous glomerulonephritis.

4. Amyloidosis of kidneys.

5. Quickly progressing glomerulonephritis.

The task 2. At opening of a corpse of the man of 43 years which have died at accruing signs of an uremia, it is revealed, that kidneys in the size 7.5х3х2.5 sm, weight 60 gram. Everyone, dense, a fibrous capsule acts in film with small work, a surface of kidneys non-uniformly fine-grained, the bark non-uniformly истончена to 0.2 sm. As such kidney is called?

1. Again wrinkled kidney.

2. Initially wrinkled kidney.

3. Atherosclerotic wrinkled kidney.

4. The amyloidosis-wrinkled kidney.

5. Pyelonephritic wrinkled kidney.

The task 3. At the child of 9 years after transferred quinsy in 10 days the uric syndrome has developed. At carrying out biopsy of kidneys microscopic it is revealed diffuse proliferation of mesangial endothelial cells, moderated инфильтрация by polimorf-nuclear leukocytes, at electronic microscopy are revealed big electron-dense subepithelial deposits, in the form of "humps". What morphological form of glomerulonephritis has developed at the child?

1. Postinfectios (poststreptococcal) glomerulonephritis.

2. Quickly progressing glomerulonephritis.

3. Membranouse glomerulonephritis.

4. Mesangial proliferative glomerulonephritis.

5. Mesangiocapilary glomerulonephritis.

The task 4. At opening of a corpse of the died 48 years which long time was ill chronic glomerulonephritis, it is revealed: kidneys in the size 8х3х2.5 sm, weight 60 gram, dense, the capsule acts in film hardly, a surface non-uniformly fine-grained, fibrinose inflammation serous and mucous membranes, dystrophic changes of parenchimatosis bodies, a brain hypostasis. What complication causes changes of internal bodies and serous covers?

1. Uremia.

2. Anemia.

3. Sepsis.

4. Sharp arterial anemia.

5. Blood depression.

The task 5. At the man of 38 years after overcooling have appeared massive proteinuria, hypostases, has developed nephrotic syndrome. At research nephrotic bioptat it is revealed, that 80 % of glomerules with epithelial “half moons”, necrosis walls of glomeruli capillaries, fibrin occurrence in a kind subendothelial deposits, tubule -interstitial component. What disease has developed at the man?

1. Quickly progressing glomerulonephritis.

2. Postinfectios glomerulonephritis.

3. Membranouse glomerulonephritis.

4. Mesangial proliferative glomerulonephritis.

5. Glomerulonephritis with the minimum changes.

The task 6. In nephrobioptate of men of 23 years are revealed following changes: proliferation of mesangial cells, swelling and proliferation of endothelial cells, increase of mesangial matrix, diffuse thickening and splitting of glomerular basal membranes, moderately expressed tubule -interstitial component, at electronic microscopy it is established interposition of mesangium, diffuse and a non-uniform thickening glomerular basal membranes. What form of glomerulonephritis has developed at the patient?

1. Mesangiocapilary glomerulonephritis.

2. Membranouse glomerulonephritis.

3. Postinfectious glomerulonephritis.

4. Quickly progressing glomerulonephritis.

5. Amyloidosis of kidneys.

The task 7. At opening of a corpse of the man of 46 years, long time ill fibrose -cavernose tuberculosis of lungs, is revealed: kidneys are increased in size, dense, on a cut have a "grease" appearance, yellow -white color, cortical layer thickness 1,2 sm., pyramids reddish. What development of process in kidneys the tuberculosis of lungs has become complicated?

1. Amyloidosis of kidneys.

2. Quickly progressing glomerulonephritis.

3. Membranouse glomerulonephritis.

4. Fibroplastic glomerulonephritis.

5. Postinfectios glomerulonephritis.

The task 8. At opening of a corpse of the man of 46 years, long time ill fibrose -cavernose tuberculosis of lungs, is revealed: kidneys are increased in size, dense, on a cut have a "grease" appearance, yellow -white color, cortical layer thickness 1,2 sm., pyramids reddish. What dye it is necessary to paint a kidney fabric at microscopic research to verify the diagnosis?


2. Sudan 3.

3. Touliding dark blue.

4. Colouring by silver.

5. On van Gizone.

Methodical instructions to work of students on practical employment «Illnesses of kidneys. Glomerulopathy ».

In the employment beginning under standards of answers check up correctness of the decision of a homework. Then by the test control your preparation for employment will be checked up.

Independently you should study macro-and micropreparations to solve situational problems.

^ It is necessary to learn macropreparations: “ Big white kidney at quickly progressing glomerulonephritis”, “ Big motley kidney at quickly progressing glomerulonephritis”, “again wrinkled kidney at chronic glomerulonephritis”, “Amyloidosis of kidneys”. Thus it is necessary to use algorithm of differential diagnostics (exhibit 1,2, exhibit № 1, «Parenchimatosis dystrophies»).

Microscopic features of glomerulopathy study on following preparations at coloring gematoksilin-eozin and a kongo-red: “Postinfectious glomerulonephritis”, “Quickly progressing glomerulonephritis”, “Mesangial Proliferative glomerulonephritis”, “Chronic glomerulonephritis. A final stage”, “Amyloidosis of kidneys”. Thus use the instruction on studying of micropreparations (exhibit № 2 , « Parenchimatosis dystrophies »).

At use micrograph, electron micrograph, tables on the given theme it is necessary to receive representation about microscopic, ultrastructural and immunofluorescense features of glomerulopathy.

Employment comes to the end with the analysis of results of independent work of each student by check of the description of micropreparations and the test control of mastering of knowledge.

^ Technological card of employment


Time in a minute

Manuals Ways of studying


Carrying out place


Check and correction of initial level


Test tasks

Educational room


Independent work. The description macro-and micropreparations.


The count of logical structure (exhibit №1), algorithm of studying of macropreparations and micropreparations

Microscope macro- and micropreparation, micrograph, tables.

Educational room


Self-examination and correction of mastering of a material.


Target training tasks

Educational room


The total test control.


Assemblage of tests

Educational room


Employment summaring.


Educational room


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