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ЗмістSpecific goals: Purpose of initial level
It is necessary to learn macropreparations
Technological card of employment
Renal diseases. Tubulopathies. Interstitial nephritis
Theme urgency: Tubulopathies are diseases of kidneys with primary leading defeat tubules and their infringement concentration, reabsorbtion and secretion functions. Tubulopathies can be got and hereditary which are caused by different forms of fermentopathies. To got tubulopathies concern: sharp necrotic nephrosis or sharp nephritic insufficiency, chronic tubulopathies - myelomal kidney and a gouty kidney. Interstitial nephrites are such diseases of kidneys which are characterised by primary defeat of interstitium and tubules. These diseases can be different in an etiology (toxic, infectious, immune, metabolic, neoplastic, mechanical) and on a disease current (sharp and chronic). In a final stage of the majority of diseases of kidneys at patients chronic nephritic insufficiency can develop, which is characterised by increase of concentration of nitrogenous slags in blood (azotemic uremia) and other clinical displays. Knowledge of the reasons, essence, mechanisms of development, morphological changes of these diseases it is necessary for the doctor for understanding of clinical displays, early diagnostics and preventive maintenance of diseases.
The purpose (general): to be able on morphological (macro-and microscopic) to a picture to distinguish displays of different forms of tubulopathies, interstitial nephrites to explain the reasons and mechanisms of their development to estimate their consequences and value for an organism.
To be able
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 microscopic research of nephritic biopsy morphologist has established, that is damaged much numbers of tubules. What function of kidneys will be broken?
1. Filtration function of kidneys.
2. Concentration function of kidneys.
3. Function will not be broken.
4. Reabsorbtion function of kidneys.
Test 2. At histologic research of kidneys it is established, that there are differences in blood supply of cortical and juxtomedullar nephrons. In what these distinctions are expressed?
1. Juxtomedullar nephrons have one capillary network.
2. Juxtomedullar nephrons two capillary networks have.
3. Juxtomedullar nephrons have no capillary network.
Test 3. At microscopic research of kidneys of the patient which was lost from a mechanical jaundice, epithelium of tubules it is presented by cells in which there were no kernels. By what generally pathologic process was developed in epithelium of tubules?
1. An atrophy of epithelium of tubules.
2. An inflammation of epithelium of tubules.
3. Necrosis of epithelium of tubules.
4. Metaplasia of epithelium of tubules.
Test 4. At the patient with a chronic abscess on a surface of kidneys plural cavities diameter 0.2 cm filled with yellow, viscous contents are defined. By what generally pathologic process was developed in kidneys?
2. A purulent inflammation.
4. A serous inflammation.
Standards of answers to the decision of tasks for self-examination and self-checking of initial level of knowledge-abilities: 1-2, 2-1, 3-3, 4-3.
The information necessary for replenishment of knowledge-abilities can be found in following references:
1. Prives M.G., Lisenko M.K. //Anatomy - М, Medicine, 1985,page 322-332.
2. Yeliseyev V. G, Afanasev J.I., Yurin I.O. //Histology, medicine, 1983, -page 530-541.
3. Strukov A.I., Serov V.V. //Pathological anatomy - М, Medicine, 1995. - page 47-105,134-152, 164-186.
4. Chair lectures on themes: "Damages", "Inflammation", “Compensatory-adaptive processes”.
5. Shlopov V.G. //Bases of pathological anatomy of the person - Kiev, 1999. - page 39-89, 124-135, 139-156.
The basic theoretical questions on which basis performance of target kinds of activity is possible.
1. Essence and modern clinic-morphological classification of illnesses of kidneys.
2. Essence and morphology of tubulopathies: sharp and chronic diseases.
3. Essence and morphology sharp necrotic nephrosis: an etiology, pathogenesis, macro-and microscopic picture, outcomes, value for an organism.
4. Essence and morphology interstitial nephrites, modern classification.
5. Essence and morphology purulent interstitial nephrite: forms, development reasons, pathogenesis, complications, outcomes, causes of death.
6. Essence and morphology tubulointerstitial nephrites: forms, reasons, development mechanism, outcomes, value for an organism.
7. Essence and uremia morphology: displays, 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. -page 411-419.
2. Chair lectures on a theme: ”Illnesses of kidneys. Tubulopathies. Interstitial nephrites”.
3. Shlopov V.G. //Bases of pathological anatomy of the person - Kiev, 1999. -page 296-304.
4. The count of logic structure of a theme ”Illnesses of kidneys. Tubulopathies. Interstitial nephrites” (exhibit 1).
5. Algorithm of morphological diagnostics of diseases of kidneys (exhibit 2, themes «Illnesses of kidneys. Glomerulopathies»).
6. The studying instruction macro-and micropreparations (exhibit 1, 2 , «Parenchimatosis dystrophies»).
The additional literature:
1. Serov V.V., Jarygin N.E., Paukov V.S. //Pathological anatomy. Atlas - М, Medicine, 1986. - page. 303-314.
2. Pathological anatomy. The Course of lectures. Under the editorship of V.V.Serov, M.A.Paltseva. - М, medicine, 1998. - page. 451-464.
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 patient of 52 years with a cancer of a head of a pancreas signs under hepatic jaundices have developed, oligoanuria and patient has died. On autopsy: kidneys are a little increased in sizes, weight 180.0 gram, flabby, the fibrous capsule acts in film very easily, a surface of kidneys pale, cortical layer grey-yellowish, pale, brain layer - cyanotic. What pathology of kidneys has complicated disease?
1. Sharp necrotic nephrosis.
2. Sharp (postinfectious) glomerulonephritis.
3. Quickly progressing glomerulonephritis.
4. Chronic glomerulonephritis.
5. Sharp pyelonephritis.
The task 2. At the patient of 52 years with a cancer of a head of a pancreas signs under hepatic jaundices have developed, oligoanuria and the patient has died. On autopsy: kidneys are a little increased in sizes, weight 180.0 gram, flabby, the fibrous capsule acts in film very easily, a surface of kidneys pale, cortical layer grey-yellowish, pale, brain layer - cyanotic. What most probable reason of development of changes in kidneys?
1. Action of bilious acids on epithelium of tubulies of kidneys.
2. Action of bacterial toxins.
3. Action sulfanilamids preparations.
4. A bacterial shock.
5. A traumatic shock.
The task 3. At the patient of 52 years with a cancer of a head of a pancreas signs underliver jaundices have developed, oligoanuria and the patient has died. On autopsy: kidneys are a little increased in sizes, weight 180.0 gram, flabby, the fibrous capsule acts in film very easily, a surface of kidneys pale, cortex layer are grey- yellowish, pale, brain layer - cyanotic. What microscopic picture is observed in kidneys?
1. Necrosis of epithelium of tubulies, tubulorrhexis, sanguineous brain layer, hypostasis and one-nuclear infiltration in stromal.
2. A sclerosis and gyalinosis majority of glomeruli, limphohistiocitar infiltration of stromal.
3. In glomerulies, epithelial ”half moons”, expressed tubule interstitial component.
4. In glomerulies, walls of vessels, basal membranes of tubulies and in stromal adjournment of the unstructured pink weights positively painted on Congo-Rot.
5. Microscopic- normal structure of kidneys.
The task 4. At the woman of 42 weeks of pregnancy operation кесарева sections has been spent. The massive bleeding has developed in the postoperative period (blood loss 3500 ml), signs anurianuria and woman was lost. On autopsy: kidneys are a little increased in sizes, weight on 200.0 gram, flabby, the fibrous capsule acts in film easily, cortex layer pale, grey-yellowish, pale, bulked up. A brain layer and juxtomedullar zone - sanguineous. What complication of operative intervention took place at the woman?
1. Hemorrhage shock.
2. A traumatic shock.
3. Cardiac shock.
4. A bacterial shock.
5. Anafilaxy shock.
The task 5. At the woman of 42 weeks of pregnancy operation кесарева sections has been spent. The massive bleeding has developed in the postoperative period (blood loss 3500 ml), signs anurianuria and woman was lost. On autopsy: kidneys are a little increased in sizes, weight on 200.0 gram, flabby, the fibrous capsule acts in film easily, cortex layer pale, grey-yellowish, pale, bulked up. A brain layer and juxtomedullar zone - sanguineous. What pathology of kidneys has complicated operative intervention?
1. Sharp necrotic nephrosis.
2. Quickly progressing glomerulonepfritis.
3. Sharp tubule interstitial nephrite.
4. A sharp pyelonephritis.
5. Sharp glomerulonephritis.
The task 6. The patient of 39 years who have transferred a trauma of a spinal cord with infringement innervation of мочевыводящих ways, has died in 11 months at the phenomena of chronic nephritic insufficiency. What disease of kidneys has complicated a trauma?
1. A chronic pyelonephritis.
2. Sharp tubule interstitial nephrite.
3. A sharp pyelonephritis.
4. Sharp necrotic nephrosis.
5. Chronic glomerulonephritis.
The task 7. Men of 46 years in a current of 12 years accepts not steroid anti-inflammatory preparations. At microscopic research of kidneys are revealed expressed interstitial fibrosis, atrophy of tubular device, expressed limphohistiocitar infiltration of stroma. What defeat of kidneys is answered with such morphological picture?
1. Chronic tubule interstitial nephrite.
2. Sharp tubule interstitial nephrite.
3. A sharp pyelonephritis.
4. A chronic pyelonephritis.
5. Sharp necrotic nephrosis.
Methodical instructions to work of students on practical employment «Renal disease. Tubulopaties. Interstitial nephrites»
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.
^ : “Sharp necrotic nephrosis”, “Bilious nephrosis”, “Sharp embolic nephrite”, “Chronic pyelonephritis”, “Fibrinose pericarditis”. Thus it is necessary to use algorithm of differential diagnostics (exhibit 1, theme «Renal disease. Glomerulopaties») and the instruction of studying of macropreparations (exhibit 1, «Parenhimatosis dystrophies»).
Microscopic features of tubulopathies study on following preparations at colouring gematoksilin-eozin “Sharp necrotic nephrosis”, “Bilious nephrosis”, “Chronic pyelonephritis”, “Fibrinose pericarditis”. Thus use the instruction on studying of micropreparations (exhibit 2, «Parenhimatosis dystrophies»).
At use microphotogrames, tables on the given theme it is necessary to receive representation about microscopic, features of tubulopaties and interstitial nephrites. 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.
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