Renal disease, and especially renal failure, can produce some of the most confusing and bewildering clinical symptoms of any organ system we will study.  Because the kidney is involved with so many regulatory functions, presenting symptoms may vary from anemia to mental confusion or even pericarditis.  But even though the symptomatology may vary dramatically, we will see there are a few common denominators.

Renal disease is in large part a replay of microvascular disease.  We will see time and again conditions that impact the functioning of capillary size blood vessels will be the principal causes of renal damage.  Antigen-antibody complex diseases, such as lupus erythematosus and post streptococcal syndromes will serve as our models for auto-immune injury.  Diabetes will weigh heavily as a major cause in many aspects of kidney pathology.  Remember that for all practical purposes, diabetes  becomes a small vessel disease.  The consequences of diabetes lead to damage of the glomeruli, interstitial tissue and even the tubular epithelium.  It should come as no surprise that diabetic renal disease is the leading cause of renal failure in the United States.

Considering infectious diseases, the kidney and lower urinary tract will show us the problem of "opportunistic" infections.  In most cases the microbial organisms causing infection of the urinary system come from our own body's normal flora.  Living in their place, the bacteria of our GI system provide us vitamin K and creates a local environment hostile to many potential pathogens.  But out of the normal habitat these same bacteria can produce life threatening infections.

Finally, neoplastic disease of the urinary system is almost in a class by itself.  We will see varied histological appearances of renal cell carcinomas as well as widely  varying clinical presentations.  But even given the wide latitude of clinical presentations and histological patterns of the tumors, if you know the basics of the physiology of of the kidney you'll be able to puzzle your way through most situations.
 

Slide 23, metastatic transition cell carcinoma in bone marrow.	Slide 79, kidney with chronic pyelonephritis.	Slide 79, kidney with chronic pyelonephritis.	Slide 80, lung with metastatic renal cell carcinoma.	Slide 80, lung with metastatic renal cell carcinoma.
Slide 91, kidney with polycystic renal disease.	Slide 95, kidney with diabetic nephropathy.	Slide 95, kidney with diabetic nephropathy.	Slide 113, kidney with acute and chronic pyelonephritis.	Slide 133, kidney with diabetic nephropathy.
Slide 135, kidney with disseminated intravascular coagulation	Slide 145, kidney with clear cell carcinoma.	Slide 164, kidney with rapidly progressive glomerular nephritis.	Slide 175, kidney with graft vs host reaction.	Slide 175, kidney with graft vs host reaction.
Slide 220, papillary adenoma and chronic pyelonepthritis	Slide 225, Transition Cell carcinoma	Normal Kidney	Normal Bladder	Normal Ureter
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Mark Braun, MD braunm@indiana.edu
Copyright 1998, the Trustees of Indiana University