RENAL PATHOLOGY

DEPARTEMEN PATOLOGI ANATOMI FK UMI

KELAINAN-KELAINAN YANG DAPAT DIJUMPAI PADA GINJAL:

KELAINAN KONGENITAL CYSTIC DISEASE PADA GINJAL GLOMERULAR DISEASE TUBULES AND INTERSTITIUM DISEASE BLOOD VESSEL DISEASE URINARY TRACT OBSTRUCTION RENAL CALCULI STONE TUMOR PADA GINJAL

ANOMALI KONGENITAL PADA GINJAL : Agenesis Kidney 2. Hypoplasia : kegagalan ginjal untuk berkembang mencapai ukuran yang normal 3. Ectopic Kidney: adanya ectopic foci akibat gangguan perkembangan bagian metaneprhros pada masa embryo 4. Horseshoe kidney : bersatunya polus superior dan inferior sehingga berbentuk seperti ladam kuda
1.

CYSTIC DISEASE OF THE KIDNEY Cystic renal Dysplasia Polycystic Kidney Disease : - Autosomal dominan (adult) - Autosomal resesif (childhood) Medullary cystic Acquired cystic (dialysis associated) Localized (simple) renal cyst Renal cyst in hereditary malformation syndromes Glomerulocystic disease Extraparenchymal renal cyst

POLYCYSTIC KIDNEY DISEASE (AUTOSOMAL DOMINANT - ADULT)

Kelainan herediter dengan karakteristik adanya kista-kista yang biasanya pada kedua ginjal merusak parenkim ginjal menyebabkan gagal ginjal

POLYCYSTIC KIDNEY

GLOMERULAR DISEASE Sering merupakan problem utama pada nefrologi Terbanyak : Glomerulonefritis kronis penyebab utama gagal ginjal kronik Biasanya diawali dengan penyakit sistemik, spt : SLE, hipertensi, polyarteritis nodosa, DM Manifestasi Klinis : - Acute nefrotik syndrom - Papillary progressive glomerlonefritis - Cronic renal failure - Asymptomatik ( proteinuria atau hematuria)

Contd

Perubahan morfologi : hipersellularity - biasanya disertai dengan proliferasi selluler dari sel mesangial atau endothelial - infiltrasi leukosit - Crescent formation penebalan basement membrane hialinisasi dan sklerosis

Hyaline arteriolosclerosis The lesions are characterized by glassy thickening of arterial and arteriolar walls. In this section an involved arteriole (arrow) is adjacent to a sclerotic glomerulus (asterisk). Hyaline arteriolosclerosis is seen in elderly patients, with or without hypertension or diabetes, and in patients with long-standing diabetes but the lesions are most common and most severe in hypertensive patients.

PENY. PADA TUBULUS DAN INTERSTITIUM Terdiri dari 2 kelompok : 1. Iskemik atau tubular injury Acute tubular necrosis Acute renal failure 2. Tubulointerstitial nefritis
Penyebab utama gagal ginjal akut

Acute tubular necrosis

Note : necrosis and sloughing of epithelial cells of the proximal convoluted tubules. The glomeruli and distal convoluted tubules are preserved

Tubulointerstitial nefritis

TUMOR PADA GINJAL

BENIGN

MALIGNANT

TUMOR GINJAL BENIGN

1. 2. 3. 4.

Renal Papillary Adenoma Renal Fibroma(Hamartoma) Angiomyolipoma Oncocytoma

Tumor Ginjal Malignant

Renal Cell Carcinoma ( Adenocarcinoma Ginjal ) - Clear Cell Ca (70% - 80%) - Papillary Ca (10% - 15%) - Chromophobe Renal Ca - Collecting Duct Ca (Bellini Duct) Urothelial Ca pada pelvis renalis

RENAL CELL CARCINOMA

Merupakan suatu keganasan yang berasal dari epitel tubulus renal 90% dari seluruh kasus keganasan yang terjadi pada ginjal Etiologi belum jelas, diduga ada hubungan dengan asap rokok, paparan zat arsenic pada industri Gejala : trias simptom hematuri, nyeri dan teraba massa pada daerah pinggang

Multilocular cystic renal cell carcinoma

Chromophobe renal cell carcinoma (RCC). Typical homogeneously tan coloured tumour of the lower pole of the kidney.

Chromophobe renal cell carcinoma

Chromophobe renal cell carcinoma comprises about 5% of epithelial renal neoplasms. Microscopically, it is composed of variably-sized cells with abundant pale reticular or flocculent cytoplasm.

Renal cell carcinoma

Renal cell carcinoma was formerly known as hypernephroma and is also called adenocarcinoma of the kidney. The most common type, clear cell carcinoma, is illustrated here. The number of cells with clear cytoplasm vs eosinophilic granular cytoplasm varies from tumor to tumor and in different sections in an individual tumor

Clear Cell Renal Cell Carcinoma

Grading Renal Cell Carcinoma : Fuhrman Grade 1 Fuhrman nuclear grading system correlated well with survival in patients with renal cell carcinoma. Grade 1 tumors have round, uniform nuclei with inconspicuous or absent nucleoli.

Renal Cell Carcinoma : Fuhrman Grade 2

Nuclear contours are more irregular than Grade 1; nuclei are about 15 microns in diameter. Nucleoli may be visible at high magnification.

Renal Cell Carcinoma : Fuhrman Grade 3 Nuclear contours are even more irregular. Nuclear diameters can approach 20 microns. Nucleoli are readily seen.

Cystic Renal Cell Carcinoma

Some cases of renal cell carcinoma are composed largely of multilocular cysts separated by thin septa containing tumor cells. The cystic nature of this tumor is illustrated in this low-power scan.

Papillary Renal Cell Carcinoma

Papillary renal cell carcinoma comprises 15% to 18% of renal cell carcinoma. Note the prominent papillary structures many of which enclose clusters of foamy macrophages.

WILLMS TUMOR Tumor primer ginjal malignant yang dijumpai pada anak Terjadi akibat kelainan gen Makroskopis : massa yang besar , bulat dan solid, warna coklat keabuan, bisa disertai hemorrhage, cyst dan nekrosis Mikroskopis : dijumpai gambaran komponen triphasic : blastema, stromal dan epitel Klinis : massa pd abdomen, nyeri, hematuria, hipertensi Prognosis baik : nefrektomi dan kemoterapi

Wilms Tumor

The triphasic nature of Wilms Tumor is obvious here. The epithelial elements surround nodules of blastema and are attempting for form rosettes. The nodules of blastem are separated by myxoid stroma.

Wilms' Tumor : Epithelium The epithelial component in this Wilms tumor consists of primitive cuboidal cells forming tubular structures and rosettes.

Wilms' Tumor : Blastema Blastema in WT consists of sheets of densely packed small blue cells with hyperchromatic nuclei, little cytoplasm and conspicuous mitotic activity