Page 691 - Textbook of Pathology, 6th Edition

675

Figure 22.22 End-stage kidney, gross appearance of short contract kidney in chronic glomerulonephritis. The kidney is small and contracted.
The capsule is adherent to the cortex and has diffusely granular cortical surface.

Patients of end-stage kidney disease on dialysis show these, renal involvement may be the initial presentation,
a variety of dialysis associated changes that include acqui- while in others clinical evidence of renal disease appears long
red cystic disease (page 659), occurrence of adenomas and after other manifestations have appeared. A list of these
adenocarcinomas of the kidney, calcification of tufts and conditions has already been given in Table 22.4. The
deposition of calcium oxalate crystals in tubules. important examples are described below.
CLINICAL FEATURES. The patients are usually adults. The Lupus Nephritis CHAPTER 22
terminal stage of chronic GN is characterised by Renal manifestations of systemic lupus erythematosus (SLE)
hypertension, uraemia and progressive deterioration of renal are termed lupus nephritis. Other clinical manifestations,
function. Besides the primary changes due to chronic renal etiology and pathogenesis of this multi-system autoimmune
failure, there are a variety of systemic manifestations of disease are described in Chapter 4 (page 78). The incidence
uraemia (page 655). These patients eventually die if they do of renal involvement in SLE ranges from 40 to 75%. The two
not receive a renal transplant. cardinal clinical manifestations of lupus nephritis are
The salient features of various types of primary proteinuria and haematuria. In addition, hypertension and
glomerulonephritis are summarised in Table 22.11. casts of different types such as red cell casts, fatty casts and
leucocyte casts in the urinary sediment are found.
II. SECONDARY GLOMERULAR DISEASES Pathogenesis of lesions in lupus nephritis is linked to

Glomerular involvement may occur secondary to certain genes related to major histocompatibility complex and B-cell
systemic diseases or a few hereditary diseases. In some of signaling pathways such as TNF superfamily members. The Kidney and Lower Urinary Tract

Figure 22.23 End-stage kidney in chronic GN, light microscopy. Glomerular tufts are acellular and completely hyalinised. Blood vessels in the
interstitium are hyalinised and thickened while the interstitium shows fine fibrosis and a few chronic inflammatory cells.