Vor die Therapie setzten die Gotter die Diagnose. Otto NiigeJi Renal biopsy has decisively enriched renal diagnostics. Kidney diseases may be monitored during their entire course, and new techniques - such as immunofluorescence and electron microscopy - may be systematically applied, resulting in novel insights into the morphogenesis, pathogenesis, and etiology of kidney lesions. These insights, in turn, have served as new starting points, in the spirit of the quotation above, for the institution of causal therapy by the clinician. This work presents our findings based on 20 years of experience in evaluating renal biopsies. As of the end of 1974, our computer-supported, systematic clinical, morphologic, and follow-up evaluation of case material consisted of over 2000 biopsies, including 679 examined by electron microscopy and 400 by immunofluorescence microscopy. The subsequent 500 biopsies (400 studied by electron microscopy and 300 by immunofluorescence) were con sidered qualitatively only. In order to enhance qualitative findings with quantitative data, it was necessary to devise new methods for quantifying electron-microscopic findings. Additionally, we attempted to correlate cyto logic and immunofluorescent observations to integrate the isolated findings of electron microscopy into a vital cytologic pattern of reactions. We also attempted to evaluate the almost overwhelming flood of publications, especially those appearing within the last 10 years. The idea for this book was conceived a decade ago. At that time, however, our own experience in renal biopsy diagnostics seemed insufficient to sup port such a major undertaking.
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Verlagsgruppe
Zielgruppe
Für höhere Schule und Studium
Für Beruf und Forschung
Research
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ISBN-13
978-3-540-08382-5 (9783540083825)
DOI
10.1007/978-3-642-66731-2
Schweitzer Klassifikation
I. Technique and General Pathology.- 1. Clinical and Procedural Aspects.- Clinical Aspects.- Procedural Aspects.- 2. Clinician's Role in Renal Biopsy Management and Processing.- Biopsy Planning.- Tissue Processing by Clinicians.- 3. Renal Biopsy Management and Processing by the Pathologist.- Light Microscopy Procedures.- Electron Microscopy Procedures.- Immunohistologic Procedures.- Morphometry Technique.- Clinically Related Topics.- 4. Histology of Normal Kidney Tissue.- Glomerulus.- Obsolescent Glomeruli.- Glomerular Morphometry.- Juxtaglomerular Apparatus.- Renal Tubules.- Blood Vessels.- Interstitium: Connective Tissue, Lymph Vessels and Nerves.- Histological Artifacts.- 5. Introduction to Renal Histopathology.- Guidelines for Evaluation of Renal Biopsy.- Definitions.- Typical Renal Lesions Under Low Power Magnification.- 6. Histopathology of the Glomerulus Under High Power Magnification.- Glomerular Size.- Hypercellularity.- Changes in Capillary Loop Lumens.- Capillary Loop Necrosis.- Pathological Capillary Loop Contents.- Changes of the Capillary Loop Wall.- Changes of Other Glomerular Capillary Wall Constituents.- Changes of the Mesangium.- Changes of the Glomerular Capsule.- Glomerular Obsolescence.- 7. Histopathology of the Juxtaglomerular Apparatus (JGA).- Limiting Factors Imposed by Biopsy.- Prognostic Value in Renal Hypertension.- Increase in JGA Size.- Decrease in JGA Size.- 8. Histopathology of the Renal Tubules.- Problems in Evaluation.- Histopathology of Complex Tubular Changes.- Cytoplasmic Changes of the Tubular Epithelium.- Nuclear Changes of the Tubular Epithelium.- EM Pathology of the Renal Tubules.- Casts.- 9. Histopathology of the Renal Interstitium.- Edema.- Sclerosis.- Fibrosis.- Inflammatory Infiltrates.- Foam Cells.- Deposits.- 10. Histopathology of the Renal Vessels.- Ultrastructural Elements in Vascular Changes.- Specific Vascular Lesions.- Arteriolar Lesions.- 11. Immunohistopathologic Parameters.- Definitions.- Diagnostic Significance of IF.- Quantification of IF Findings.- IF Deposition Character.- Significance of Immunoglobulins and Other Proteins in Glomerulopathy.- Additional Glomerular IF Findings.- IF Findings in Nonglomerular Structures.- Cryoglobulins and Kidney.- 12. General Differential Diagnosis Between Non-Glomerulonephritic Nephropathies and Glomerulonephritis.- II. Histopathology of Specific Renal Disease States.- 13. General Aspects of Glomerulonephritis.- Nosology.- Basic Morphologic Parameters of Glomerulonephritis.- Special Clinical Courses of Glomerulonephritis.- General Pathogenesis of Glomerulonephritis.- Immunocomplex Glomerulonephritis.- General Etiology of Glomerulonephritis.- 14. The Diffuse Forms of Glomerulonephritis.- Diffuse Endotheliomesangial Glomerulonephritis.- Extracapillary Accentuated Glomerulonephritis.- Membranoproliferative Glomerulonephritis.- Intramembranous Glomerulonephritis.- Epimembranous Glomerulonephritis.- Mixed Form of Epimembranous and Membranoproliferative Glomerulonephritis.- 15. Focally Accentuated Glomerulonephritis.- Embolic, Purulent Focal Glomerulitis, and Thrombotic-Induced Glomerulonephritis.- Embolic Purulent Focal Glomerulitis.- Segmental-Focal Glomerulonephritis in Subacute Bacterial Endocarditis.- Segmental-Focal Glomerulonephritis Associated With Generalized Intravasal Coagulation.- Segmental-Focal Proliferative and Sclerosing Glomerulonephritis, Focal-Global Sclerosing Glomerulonephritis and Overload Glomerulitis.- Segmental-Focal Proliferative Glomerulonephritis (Proliferative FGN).- Segmental-Focal Sclerosing Glomerulonephritis (Sclerosing FGN).- Focal-Global Sclerosing Glomerulonephritis.- Overload Glomerulitis.- 16. Glomerulonephritic Contracted Kidney (Nonclassifiable Glomerulonephritis, End-Stage Kidney).- 17. Special Forms of Glomerulonephritis.- Diffuse and Focally Accentuated Glomerulonephritis Associated With Systemic Disease.- Glomerular Disease in Schönlein-Henoch's Purpura.- Glomerular Disease in Systemic Lupus Erythematosus.- Renal Changes in Goodpasture's Syndrome.- Renal Changes in Wegener's Syndrome.- Glomerulonephritis in Hypersensitivity Angitis (Microform of Periarteritis Nodosa).- IgA Mesangial Glomerulonephritis.- Early Infantile Glomerulonephritic Contracted Kidney (So-Called Oligonephronia).- 18. Glomerular Minimal Change.- 19. Glomerulonephrosis and Glomerulosclerosis.- Idiopathic Unspecific Glomerulonephrosis and Glomerulosclerosis.- Amyloid Nephrosis.- Diabetic Glomerulosclerosis.- Hepatic Glomerulosclerosis.- Glomerulopathy of Pregnancy.- Kidney in Plasmocytoma.- Glomerulosclerosis in Waldenström's Disease.- 20. Inflammatory Interstitial Renal Lesions.- Acute, Nondestructive Interstitial Nephritis.- Chronic Interstitial Nephritis.- Pathogenesis of Acute Reversible Renal Failure.- Weil's Jaundice. The Kidney in Leptospirosis Ictero-Hemorrhagica Infection.- Pyelonephritis (Destructive Interstitial Nephritis).- Pyelonephritic Contracted Kidney of Early Childhood.- Montaldo's Pyelonephritis.- Balkan Nephropathy.- Renal Changes in Phenacetin Addiction.- Combination of Pyelonephritis and Glomerulonephritis.- 21. Kidney Tuberculosis and Rare Kidney Infections.- Renal Tuberculosis.- Brucellosis.- Echinococcus.- Sarcoidosis.- Tuberculoid Granuloma of Uncertain Etiology.- Actinomycosis.- Aspergillosis.- Cytomegalovirus Infection.- 22. Hydronephrosis and Nephrohydrosis.- 23. Enzymopathic, Metabolic Renal Diseases.- Fabry's Disease.- Cystinosis.- Renal Oxalosis.- Kidney in Gout.- Alport's Syndrome.- Idiopathic and Benign Familial Hematuria.- Nail-Patella Syndrome.- Primary Tubulopathy.- Secondary Fanconi Syndrome.- Nephronophthisis.- Nephrocalcinosis.- Toxic and Metabolic Tubulonephrosis.- 24. Renal Changes Caused by Impairment of the Circulatory System.- Anoxic Glomerular Lesions.- Hemorrhage.- Fat Embolism.- Kidney in Shock.- Disseminated Intravasal Coagulation Including Cortical Necrosis.- 1. Acute Disseminated Intravasal Coagulation.- 2. Subacute and Chronic (Relapsing) Disseminated Intravasal Coagulation.- 3. The Hemolytic-Uremic Syndrome.- 4. Thrombotic Microangiopathy.- Renal Vein Thrombosis.- Kidney Infarct.- Subinfarct.- 25. Renal Changes Caused by Vascular Disease.- Arteriolosclerosis.- Arteriolonecrosis.- Fibroelastosis.- Scleroderma.- Arterial Intimai Proliferation Associated With Female Hormones.- Neurofibromatosis.- Inflammatory Vascular Diseases.- 1. Unspecific Arteritis.- 2. Periarteritis Nodosa.- 3. Hypersensitivity Angitis.- 4. Other Inflammatory Diseases of the Renal Arteries.- 26. Unilateral Contracted Kidney and Renal Hypertension.- 27. The Kidney in Radiation Injury.- 28. Malformations of the Kidney.- Primary Hypoplasia.- Secondary Hypoplasia.- Dyplasia.- Kidney Cysts and Cystic Kidneys.- 29. Kidney Tumors.- Mesenchymal Tumors.- 1. Benign and of Questionable Malignancy.- 2. Malignant Tumors (Sarcomas).- 3. Renal Capsule Sarcoma.- Epithelial Tumors.- 1. Benign and of Questionable Malignancy.- 2. Renal Cell Carcinoma.- 3. Renal Pelvic Carcinoma.- Mixed Tumor: Nephroblastoma.- Metastases.- 30. Kidney Transplantation.- Immunogenetics.- Indications for Biopsy.- Acutely Imminent Renal Injury (So-Called Conservation Injury).- Peracute (Hyperacute) Transplant Rejection.- Acute Transplant Rejection.- 1. Acute Interstitial Transplant Rejection.- 2. Acute Vascular Transplant Rejection.- 3. Differential Diagnosis of Peracute and Acute Transplant Rejection.- Chronic Transplant Rejection.- 1. Chronic Transplant Glomerulopathy.- 2. Chronic Transplant Vasculopathy.- 3. Interstitial and Tubular Changes.- 4. Differential Diagnosis of Chronic Transplant Rejection.- Pathogenesis of Transplant Rejection.- Complications.- References.
