Pathology: Renal and Urology 1 Flashcards
What is pyelonephritis?
Infection of the renal pelvis, calyces, tubules and interstitium
In which two ways can pyelonephritis present?
Acute or chronic
Which type of distribution is associated with pyelonephritis?
Diffuse
What is the most common organism responsible for causing pyelonephritis?
E. coli
(bacteria are most common)
What are the risk factors for pyelonephritis?
Young females
Pregnancy (ureteric dilatation causing stasis)
Instrumentation from surgery
Obstruction (tumour, stricture, stones etc)
Diabetes
Vesico-ureteric reflux
What is the vesico-ureteric reflux?
Distal ureters fail to enter the bladder obliquely meaning the perpendicular angle allows reflux of urine upon contraction of the bladder
How does chronic pyelonephritis present?
Hypertension +/- uraemia
Large volumes of urine
Vague symptoms
How does tuberculosis pyelonephritis occur?
Usually from haematogenous spread from the lungs
Why does sterile pyuria occur with tuberculosis pyelonephritis?
Bacteria grows at a slower rate compared with other bacteria
This means pus will be present in the urine, but it appears sterile initially
Besides sterile pyuria, which other symptoms or signs may be present in tuberculosis pyelonephritis?
Vague symptoms; weight loss, fever, loin pain, dysuria
Which condition often occurs alogside pyelonephritis?
Cystitis
What is cystitis?
Inflammation of the bladder
Cystitis normally presents with acute inflammation, what can it progress to and under which circumstance?
Necrosis
Outflow obstruction
For which reason does cystitis commonly occur alongside pyelonephritis?
Pyelonephritis often occurs as an ascending condition up the urinary tract
What are the main causes of cystitis?
E. coli
Klebsiella
Proteus
Pseudomonas
Cystitis cystica is associated with which histological appearence?
Many small fluid filled cysts projecting into the lumen
What is the causative organism for schistosomiasis?
S. Haematobium
Schistosomiasis can predispose to what?
Urothelial malignancy, particularly Squamous Carcinoma
What are the main causes for urethral obstruction?
Stricture
Posterior urethral valves
Prostatic disease
Prolonged bladder outlet obstruction can lead to what?
Hypertrophy of detrusor muscle and formation of diverticulum
What are the main causes of hydronephrosis?
Urinary tract obstruction
Reflux
Unilateral hydronephrosis has which main causes?
Calculi
Neoplasma
Strictures
Pelvic-ureteric constriction
What are the main causes for bilateral hydronephrosis?
Urethral obstruction
Neurogenic disturbance
VUR
Bilateral ureteric obstruction (e.g. advanced carcinoma of cervix)
Hydronephrosis commonly develops into which other condition due to the associated urinary stasis?
Pyelonephritis
What changes does hydronephrosis cause to the renal system?
Dilatation of pelvicalyceal system with parenchymal atrophy
If there is pelvicalyceal dilatation associated with hydronephrosis, what does this suggest about the condition?
It has taken a gradual path with a partial obstruction
