Pathology Flashcards
What is glomerulonephritis
Non-infective
glomerular tufts with secondary tubulo-interstitial changes
Usually diffuse, may be focal
What usually causes glomerulonephritis
Immunological mechanisms often after an upper respiratory tract infection
What is pyelonephritis
A bacterial infection of the renal pelvis, calyces, tubules and interstitial
What are the common presenting symptoms of pyelonephritis
Pyrexia, sweating an other GU symptoms
What is the commonest organism seen in pyelonephritis
E Coli
Also pseudomonas, strep or fungi
Pyelonephritis is more common in who? men or women
women
What is the pathogenesis of pyelonephritis
Blood-borne (rare) in septicaemia, post surgery
due to ascending infection from the more distal end of the urinary tract (cystitis)
What are some of the risk factors for pyelonephritis
Age and sex:
Females (shorter, wider urethra)
Pregnancy (ureteric dilatation
Instrumentation or surgery carries a risk of UTI
UT Obstruction e.g. calculus, stricture, neoplasm congenitla anomaly, prostatic and urethral pathology (elderly males)
Diabetics
Vesico-ureteric reflex - if ureters are more perpendicular, then infection can travel back up to the kidney
What is the main inflammatory cell seen in pyelonephritis
Neutrophil
What are the signs and symptoms of chronic pyelonephritis
Often no previous history of UTI
Vague symptoms
Hypertension and / or uraemia (uric acid level)
Large volume of urine
Coarse cortical scarring and distortion of calyces on renal imaging
Why is there large volumes of urine passed in a patient with chronic pyelonephritis
The kidney is scarred and so the patient can’t concentrate the urine
What is lost and in pyelonephritis and what replaces it
Glomerular loss and replaced by a hyaline ball of connective tissue
How is tuberculous pyelonephritis spread
Haematologically spread usually from the lung
What are the symptoms and signs of tuberculous pyelonephritis
Vague symptoms: weight loss, fever, long pain, dysuria
Sterile pyuria
How is TB pyelonephritis diagnosed
PCR
What organisms cause cystitis
E Coli
Klebsiella
Proteus
Pseudomonas
What can resemble tumours in cystitis
Ureteritis and cystitis Cystica
Why does urinary tract obstruction result in hypertrophy of the muscle lining
Prolonged outlet obstruction causes more urine to be held in the bladder for longer which causes an increase in pressure
What is hydronephrosis
Dilatation of pelvicalyceal system with parenchymal atrophy
What are the 2 main causes of hydronephrosis
Urinary tract obstruction and reflux
What structure usually results in bilateral hydronephrosis
The urethra
neurogenic disturbance
VUR
bilateral ureteric obstruction e.g. advanced carcinoma of cervix
What usually causes unilateral hydronephrosis
Presence of stones but can also be neoplasms
What type of obstruction is more likely to cause hydronephrosis
Gradual, partial or intermittent obstruction compared to a sudden and complete
Why does pyonephrosis sometimes occur in hydronephrosis
Secondary infection often follows stasis
Describe the typical appearance of detrusor muscle hyperplasia
Typical criss cross pattern
