Nephrology is a specialty of adult internal medicine and pediatric medicine that concerns the study of the kidneys, specifically normal kidney function and kidney disease, the preservation of kidney health, and the treatment of kidney disease, from diet and medication to renal replacement therapy. The word "renal" is an adjective meaning "relating to the kidneys", and its roots are French or late Latin. Whereas according to some opinions, "renal" and "nephro" should be replaced with "kidney" in scientific writings such as "kidney medicine" or "kidney replacement therapy", other experts have advocated preserving the use of renal and nephro as appropriate including in "nephrology" and "renal replacement therapy", respectively.
Pathology is the study of disease and injury. The word pathology also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in the context of modern medical treatment, the term is often used in a narrower fashion to refer to processes and tests that fall within the contemporary medical field of "general pathology", an area that includes a number of distinct but inter-related medical specialties that diagnose disease, mostly through analysis of tissue and human cell samples. Idiomatically, "a pathology" may also refer to the predicted or actual progression of particular diseases, and the affix pathy is sometimes used to indicate a state of disease in cases of both physical ailment and psychological conditions. A physician practicing pathology is called a pathologist.
Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as either acute kidney failure, which develops rapidly and may resolve; and chronic kidney failure, which develops slowly and can often be irreversible. Symptoms may include leg swelling, feeling tired, vomiting, loss of appetite, and confusion. Complications of acute and chronic failure include uremia, hyperkalaemia, and volume overload. Complications of chronic failure also include heart disease, high blood pressure, and anaemia.
Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of immunosuppressant drugs after transplant.
Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection. Symptoms most often include fever and flank tenderness. Other symptoms may include nausea, burning with urination, and frequent urination. Complications may include pus around the kidney, sepsis, or kidney failure.
Acute tubular necrosis (ATN) is a medical condition involving the death of tubular epithelial cells that form the renal tubules of the kidneys. Because necrosis is often not present, the term acute tubular injury (ATI) is preferred by pathologists over the older name acute tubular necrosis (ATN). ATN presents with acute kidney injury (AKI) and is one of the most common causes of AKI. Common causes of ATN include low blood pressure and use of nephrotoxic drugs. The presence of "muddy brown casts" of epithelial cells found in the urine during urinalysis is pathognomonic for ATN. Management relies on aggressive treatment of the factors that precipitated ATN. Because the tubular cells continually replace themselves, the overall prognosis for ATN is quite good if the underlying cause is corrected, and recovery is likely within 7 to 21 days.
Interstitial nephritis, also known as tubulointerstitial nephritis, is inflammation of the area of the kidney known as the renal interstitium, which consists of a collection of cells, extracellular matrix, and fluid surrounding the renal tubules. It is also known as intestinal nephritis because the clinical picture may include mesenteric lymphadenitis in some cases of acute pyelonephritis. More specifically, in case of recurrent urinary tract infection, secondary infection can spread to adjacent intestine. In addition to providing a scaffolding support for the tubular architecture, the interstitium has been shown to participate in the fluid and electrolyte exchange as well as endocrine functions of the kidney.
Adenine phosphoribosyltransferase deficiency is a rare autosomal recessive metabolic disorder caused by mutations of the APRT gene. Adenine phosphoribosyltransferase (APRT) catalyzes the creation of pyrophosphate and adenosine monophosphate from 5-phosphoribosyl-1-pyrophosphate and adenine. Adenine phosphoribosyltransferase is a purine salvage enzyme. Genetic mutations of adenine phosphoribosyltransferase make large amounts of 2,8-Dihydroxyadenine causing urolithiasis and renal failure.
Rapidly progressive glomerulonephritis (RPGN) is a syndrome of the kidney that is characterized by a rapid loss of kidney function, with glomerular crescent formation seen in at least 50% or 75% of glomeruli seen on kidney biopsies. If left untreated, it rapidly progresses into acute kidney failure and death within months. In 50% of cases, RPGN is associated with an underlying disease such as Goodpasture syndrome, systemic lupus erythematosus or granulomatosis with polyangiitis; the remaining cases are idiopathic. Regardless of the underlying cause, RPGN involves severe injury to the kidneys' glomeruli, with many of the glomeruli containing characteristic glomerular crescents.
The International Society of Nephrology (ISN) is an organization concerned with kidney health.
Light chain deposition disease (LCDD) is a rare blood cell disease which is characterized by deposition of fragments of infection-fighting immunoglobulins, called light chains (LCs), in the body. LCs are normally cleared by the kidneys, but in LCDD, these light chain deposits damage organs and cause disease. The kidneys are almost always affected and this often leads to kidney failure. About half of people with light chain deposition disease also have a plasma cell dyscrasia, a spectrum of diseases that includes multiple myeloma, Waldenström's macroglobulinemia, and the monoclonal gammopathy of undetermined significance premalignant stages of these two diseases. Unlike in AL amyloidosis, in which light chains are laid down in characteristic amyloid deposits, in LCDD, light chains are deposited in non-amyloid granules.
Renal cortical necrosis (RCN) is a rare cause of acute kidney failure. The condition is "usually caused by significantly diminished arterial perfusion of the kidneys due to spasms of the feeding arteries, microvascular injury, or disseminated intravascular coagulation" and is the pathological progression of acute tubular necrosis. It is frequently associated with obstetric catastrophes such as abruptio placentae and septic shock, and is three times more common in developing nations versus industrialized nations.
Transplant glomerulopathy(TG) is a morphologic lesion of renal allografts that is histologically identified by glomerular basement membrane (GBM) duplication and/or multilayering. Proteinuria, hypertension, and deteriorating graft function are the hallmarks of TG.
The Banff Foundation for Allograft Pathology also known as the Banff Foundation for Transplant Pathology is a nonprofit Swiss foundation which aims to "lead development and dissemination of the international Banff Classification of Allograft Pathology and to facilitate multidisciplinary, collaborative research to enhance its scientific basis and clinical utility to improve the care of transplant patients". Its predecessor group had organized transplant pathology meetings in every odd numbered year since 1991 and the Foundation has specific future meeting plans through 2025. The meetings establish and maintain the worldwide standards for tissue biopsy reporting and diagnosis of transplant rejection through consensus decision making. They thereby provide an essential service to the field of allotransplantation. The goals of the Banff foundation are to facilitate knowledge generation and translation in transplantation pathology with the ultimate aim of improving patient outcomes, maintaining the Banff meeting spirit of a multinational, multidisciplinary consensus group, raising funds for research and education in transplantation pathology, providing guidance and financial support for Working Group activities and Banff meetings activities. Kim Solez is the Chair of the Banff Foundation for Allograft Pathology. The 2015 Banff Conference for Allograft Pathology was held in conjunction with the Canadian Society of Transplantation in Vancouver, BC, and included consideration of molecular pathology and tissue engineering pathology as well as traditional light microscopy, immunofluorescence, and electron microscopy. The 2017 Banff Conference was held in Barcelona, Spain. The 2019 Banff Conference was held in Pittsburgh, Pennsylvania, and the 2021 Banff Conference will be in Banff, Alberta, Canada.
The Banff Classification is a schema for nomenclature and classification of kidney transplant pathology, established in 1991 by Kim Solez and Lorraine C. Racusen in Banff, Canada. The initiative was "inspired by the then recent development of a consensus grading system for diagnosis of rejection in cardiac allografts led by Dr Margaret Billingham, a key participant at the first Banff transplant pathology meeting". Prior the Banff Classification there was no standardized, international classification for renal allograft biopsies, which resulted in considerable heterogeneity among pathologists in characterization of renal allograft biopsies. The first Banff schema was published in 1993, and has since undergone updates at regular intervals. The classification is expanded and updated every two years in meetings organized by the Banff Foundation for Allograft Pathology. An evaluation of the Banff Classification in March 2000 confirmed significant association between the revised Banff '97 classification and graft outcome. The classification is unusual in that there is no competing standard. It has been used worldwide for 28+ years and shows how useful consensus meetings in a medical subspecialty area can be. In 2018 a user guide for the classification was published in the journal Transplantation.
William James Dempster was a British surgeon and researcher in organ transplantation at St Mary’s Hospital, London. He published more than 100 scientific reviews and papers on kidney transplant rejection in dogs, confirming that rejection was an example of immune response, mediated by serum antibodies.
Alexandre Loupy is a French nephrologist, a university professor and hospital practitioner at the Necker Hospital of the Assistance Publique - Hôpitaux de Paris, in the kidney transplant department. He is known for his discoveries on the topic of graft rejection.,, Its approach proposing innovative methodological tools has led to a better understanding but has also led to important changes in the international classification of graft rejection., These discoveries allow to improve the performance of clinical trials and to consider new therapeutic innovations in transplantation.
Papillary renal cell carcinoma (PRCC) is a malignant, heterogeneous tumor originating from renal tubular epithelial cells of the kidney, which comprises approximately 10-15% of all kidney neoplasms. Based on its morphological features, PRCC can be classified into two main subtypes, which are type 1 (basophilic) and type 2 (eosinophilic).
Javed Iqbal Kazi (1955–2014) was a Pakistani pathologist specialized in renal pathology, professor and chairman of Histopathology at Karachi Medical and Dental College, Sindh Institute of Urology & Transplantation, Dr. Ziauddin Hospitals & National Institute of Blood Diseases, and served as Dean of medicine of University of Karachi. He was also the board member of Journal of Pakistan Medical Association since 2005. He established the department of Histopathology at Sindh Institute of Urology & Transplantation, Karachi, in 1995 and is the pioneer of Renal and Transplant Pathology in Pakistan.
Agnes B. Fogo is a professor of renal pathology at the Vanderbilt University Medical Center.
