kidney pathology

kidney

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Normal

capsule
cortex
- tubules should be back-to-back
medulla
sinus
vasculature
- arteries should have minimal intima
development
- nephrogenic zone (blue tubules and blastemal cells) up to 35 weeks
- rare scattered glomerulosclerosis is normal
- should have 10 rows thick of glomeruli by 36 weeks

Non-neoplastic

vascular
- diabetic nephropathy
- hypertension
  - nephrosclerosis
  - thrombotic microangiopathy
- renal artery stenosis
  - atherosclerosis
  - fibromuscular dysplasia
- ischemia
- mechanical
  - dissection
  - aneurysm
cystic
acute kidney injury
- tubulointerstitial
  - ATN
  - AIN
  - cast nephropathy
- glomerular
  - acute glomerulonephritis
  - RPGN
  - thombotic microangiopathy
- rejection
inflammation
structural
- horseshoe kidney
- ectopia
- agenesis
Renal pelvis (see bladder)
renal transplant

WHO neoplasms

Renal cell
- clear cell RCC
- multilocular cystic RCC
- papillary RCC
- chromophobe RCC
- collecting duct carcinoma
- renal medullary carcinoma
- translocation RCC
- neuroblastoma associated carcinoma
- mucinous tubular and spindle cell carcinoma
- RCC unclassified
- papillary adenoma
- oncocytoma
- other
  - acquired RCC
  - tubulocystic RCC
  - clear cell tubulopapillary RCC
  - hereditary leiomyomatosis/RCC syndrome associated RCC
Metanephric
Nephroblastic
Mesenchymal
- pediatric
- adult
  - leiomyosarcoma
  - angiosarcoma
  - rhabdomyosarcoma
  - malignant fibrous histiocytoma
  - solitary fibrous tumor
    - hemangiopericytoma
  - osteosarcoma
  - angiomyolipoma
    - epithelioid angiomyolipoma
  - leiomyoma
  - hemangioma
  - juxtaglomerular cell tumor
  - renomedullary interstitial cell tumor
  - schwannoma
Mixed mesenchymal and epithelial
- cystic nephroma
- mixed epithelial and stromal tumor
- synovial sarcoma
Neuroendocrine
hematolymphoid
GCTs
- teratoma
- choriocarcinoma
metastasis

Grading

ISUP
- G1: absent or inconspicuous nucleoli at 40x
- G2: nucleoli clearly visible at 40x
- G3: nucleoli clearly visible at 10x
- G4: extreme pleomorphism, rhabdoid or sarcomatoid
- validated for clear cell and papillary RCC
- Chromophobe RCC not graded
- other RCC for descriptive purposes
Fuhrman
- G1: uniform nuclei
- G2: irregular nuclei
- G3: prominent nucleoli
- G4: ugly

TNM

T1: <= 7cm
- T1a: <= 4cm
- T1b: 4-7cm
T2: > 7cm
- T2a: 7-10cm
- T2b: > 10cm
T3: perirenal, major veins extension
- T3a: renal vein, muscular branches, perirenal fat, sinus
- T3b: vena cava
T4: Gerota fascia, adrenal gland invasion

Staging

Stage I: T1, N0, M0
Stage II: T2, N0, M0
Stage III
- T1-2, N1, M0
- T3, N0-1, M0
Stage IV
- T4, M0
- M1