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Related Concept Videos

Glomerular Filtration01:15

Glomerular Filtration

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The filtration membrane in the renal system is a highly specialized structure essential for filtering blood. It consists of glomerular capillaries and podocytes, forming a selective barrier that permits the passage of water and small solutes while restricting most plasma proteins and blood cells.
Components of the Filtration Membrane
The filtration process involves three key layers: the glomerular endothelial cells, the basement membrane, and the podocyte-formed filtration slits.
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Glomerular Filtration Rate and its Regulation01:28

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The Glomerular Filtration Rate (GFR) is a measure of kidney function, reflecting the volume of filtrate formed per minute in the kidneys. On average, GFR is approximately 125 mL/min in males and 105 mL/min in females. Maintaining a relatively constant GFR is essential for the kidneys to effectively regulate body fluid homeostasis and maintain extracellular stability.
GFR regulation involves two primary intrinsic controls: the myogenic and tubuloglomerular feedback mechanisms.
The myogenic...
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Glomerular Filtration: Net Filtration Pressure01:26

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Glomerular filtration, a key process in the kidneys, is regulated by three main pressures: Glomerular blood hydrostatic pressure (GBHP), Capsular hydrostatic pressure (CHP), and Blood colloid osmotic pressure (BCOP).
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Renal Drug Excretion: Glomerular Filtration01:02

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The kidney serves as the primary organ responsible for eliminating drugs and their metabolites from the body. This process, known as renal elimination, starts with glomerular filtration and results in urine formation. Each kidney houses millions of functional units called nephrons, where urine production occurs. A nephron has two main components: a renal corpuscle and a renal tubule.
Drugs gain access to the kidney via the renal artery, which progressively branches off into afferent arterioles....
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Drug Elimination by Renal Route: Glomerular Filtration01:17

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The kidney serves as the primary organ responsible for eliminating drugs and their metabolites from the body. This process, known as renal elimination, starts with glomerular filtration and results in urine formation. Each kidney houses millions of functional units called nephrons, where urine production takes place. A nephron has two main components: a renal corpuscle and a renal tubule. Drugs gain access to the kidney via the renal artery, which progressively branches off into afferent...
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Physiology of the Genitourinary System I: Renal Blood Flow and Glomerular Filtration01:29

Physiology of the Genitourinary System I: Renal Blood Flow and Glomerular Filtration

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The kidneys are vital organs responsible for regulating blood filtration, waste excretion, and fluid balance, all of which are crucial for maintaining homeostasis. Renal physiology examines renal blood flow, glomerular filtration, and urine formation, ensuring the body’s internal environment remains stable.Renal Blood FlowThe kidneys receive about 20-25% of the cardiac output, typically around 1200 mL of blood per minute in an average adult. Blood flows into the kidneys through the renal...
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Bevacizumab-associated glomerular microangiopathy.

Fermin Person1, Markus M Rinschen2,3, Silke R Brix4

  • 1Institute of Pathology and Nephropathology Section, University Hospital Hamburg Eppendorf, Hamburg, Germany.

Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc
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Summary

Bevacizumab cancer therapy can cause a unique kidney injury, distinct from thrombotic microangiopathy. This hyaline occlusive glomerular microangiopathy presents with pseudothrombi and is diagnosed via light microscopy.

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Area of Science:

  • Nephrology
  • Oncology
  • Pathology

Background:

  • Bevacizumab, a cancer therapeutic antibody, is associated with renal adverse events like proteinuria and nephrotic syndrome.
  • Previous reports suggest bevacizumab-induced thrombotic microangiopathy (TMA), but distinct histopathological patterns may exist.

Purpose of the Study:

  • To characterize the unique histopathological and clinical features of renal damage in patients treated with bevacizumab.
  • To differentiate bevacizumab-associated nephropathy from other glomerular diseases, including TMA.

Main Methods:

  • Retrospective analysis of 17 renal biopsies from patients receiving bevacizumab.
  • Assessment of clinical, laboratory, light microscopy, immunohistochemistry, proteomics, and electron microscopy findings.
  • Comparison with biopsies diagnosed with TMA, FSGS, and cryoglobulinemic glomerulonephritis.

Main Results:

  • All 17 patients exhibited nephrotic syndrome and a unique pattern of hyaline pseudothrombi occluding glomerular capillaries.
  • Proteomic analysis revealed protein accumulation in pseudothrombi, with features of TMA and cryoglobulinemic glomerulonephritis.
  • Pseudothrombi lacked platelets (CD61+) and fibrin polymers, distinguishing them from TMA.

Conclusions:

  • Bevacizumab therapy can induce a distinct hyaline occlusive glomerular microangiopathy, differing from TMA.
  • This condition likely results from endothelial leakage and subendothelial protein accumulation.
  • It is an important differential diagnosis for nephrotic syndrome in cancer patients undergoing bevacizumab treatment.