Virtual Microscopy	Choose another topic Cardiovascular Respiratory Renal and Urinary Tract Musculoskeletal Neuro(CNS and PNS) Gastrointestinal Reproductive Endocrine Hematopoiesis and Lymphoid Skin

Case 1:

An 18-year-old male was referred for evaluation of proteinuria. He was trying out for the freshman college football team and the proteinuria was discovered during a routine physical examination. The proteinuria was subsequently quantitated to 3.0g/24hr and he was referred for further evaluation. During history and physical examination, he stated that he has noticed swelling of his lower extremity and has not been feeling as well as usual. A kidney biopsy was performed and it was interpreted as representing minimal change disease. Your slide is a representation of normal kidney. One electron micrograph is from a normal glomerulus and the other is from a patient with minimal change disease.

Slides: [normal kidney] [minimal change disease]

Electron micrographs: [normal glomerulus] [minimal change disease]

1. Identify the glomeruli. What is their function? Where are the capillary loops? Where is Bowman’s space and what are its contents? How do the glomeruli receive their blood supply? Can glomeruli regenerate? What does a sclerotic glomerulus look like?
2. Review the two electron micrographs. The one with minimal change disease has fusion of the podocytes or epithelial foot processes. Identify the podocytes in each micrograph. What do the podocytes line? What type of cell lines the capillary loop? Identify the basement membrane. What are the lamina rara interna and extrerna? What type of collagen comprises the basement membrane?
3. How does the kidney receive its vascular supply? Where is the juxtaglomerular appartus located?

Case 2:

A 75-year-old female who has many medical problems developed flu like illness. She had diarrhea and complained of loss of appetite. She developed acute renal failure and a diagnosis of acute tubular necrosis was made. The histologic findings in acute tubular necrosis may be limited, but it allows us the opportunity to review renal tubular histology.

Electron Micrograph: [normal renal tubule]

1. Where do the proximal tubules originate?
2. What do the distal tubules drain into?
3. What comprises the loop of Henle?
4. Where are the collecting ducts and tubules?
5. What is the difference between renal cortex and renal medullae?
6. What cell type do most renal carcinomas originate from?
7. What cell type lines the renal tubules?
8. Where do the collecting ducts drain?
9. What cell type lines the renal pelvis?
10. Review the electron micrograph of a renal tubule. Identify the epithelial cells and microvilli. What is the function of the microvilli? Can you identify any cellular organelles in the cytosol?

Case 3:

A 45-year-old male presents with right sided flank pain. He has normal urine output and no significant prior health problems. His pain was only partially relieved by narcotic analgesics. He came to the emergency room and a small calculus was identified in his ureter. Four hours later the stone was passed in his urine and sent for analysis. He had an uneventful recovery. Review your histologic section of ureter.

Slide: [normal ureter]

1. Identify the various epithelial and muscular layers of ureter.
2. What cell type lines the ureter?
3. What muscle type is in the ureter wall?
4. Why should the stone be sent for analysis?
5. How does the histology of the ureter compare with that of the bladder? [normal bladder]