Pyelonephritis/hydronephrosis

Question 1

What is pyelonephritis? Which gender is more susceptable? what kind of distribution does it exist in? what are the causal organisms? when is chronic pyelonephritis usually seen?

Answer 1

Pyelonephritis: bacterial infection of renal pelvis/calyces/tubules/interstitium

F>M

Patchy distribution

E.coli most common, also psuedomonas/strep. faecalis

Chronic PN is usually seen in the clinical setting

Question 2

What are the 3 different pathogeneses for pyelonephritis?

Answer 2

• Blood borne in septicaemia
• Post-surgery
• Ascending infection

Question 3

What 7 risk factors exist for pyelonephritis?

Answer 3

• Age and sex
• pregnancy
• instrumentation
• obstruction of urinary tract (prostate, urethra, calculi, stricture, tumour)
• vesico-ureteric reflux (congenital or acquired)
• diabetes

Question 4

Chronic pyelonephritis:

• is there usually a previous history of UTI?
• what are the two clinical features?
• what is seen on imaging kidney?

Answer 4

-usually no previous history UTI

Clinical features: high BP +/- uraemia, large volume of urine

Imaging: course cortical scarring, distorted calyces, shrunken kidney

Question 5

Tuberculosis PN:

• what is the pathogenesis?
• symptoms 4
• signs
• diagnosis

Answer 5

-haemotogenous spread TB from kidney causes caseous (necrotising) foci with progressive renal obstruction, spreading to ureters/bladder/other viscera

Symptoms: fever/weight loss/loin pain/dysuria

Signs: sterile pyuria (TB takes a while to culture)

Diagnosis: typical caseating granulomatous infection (don’t need to see Z/N stain)

Question 6

What is cystitis? what are the causal organisms? what are the features of cystitis?

Answer 6

Cystitis: bladder infection
-e.coli, klebsiella, proteus, pseudomonas

Features: acute inflammation but can become necrotising if assoc. outlet obstruction

Question 7

What is ureteritis and cystitis cystica?

Answer 7

Cysts in ureter/cysts in bladder

• multiple fluid filled cysts projecting into lumen
• can resemble tumours

Question 8

Schistosomiasis: what does this increase the risk of?

Answer 8

• tropical countries

- increased risk of squamous cell carcinoma bladder

Question 9

Hydronephrosis:

• what is this?
• features?
• causes if bilateral 4
• causes if unilateral 4

Answer 9

=Water in kidney

Features: dilatation of pelvicalyceal system and parenchymal atrophy

Bilateral: urethral obstruction, neurogenic disturbance, vesico-ureteric reflux, bilateral ureteric obstuction e.g. carcinoma cervix

Unilateral: stones, strictures, tumour, pelvi-ureteric obstruction

Question 10

If the obstruction is sudden and complete, how does this differ from if the obstruction was partial and gradual?

Answer 10

Sudden and complete - little pelvicalyceal dilatation and no urine production

Partial and gradual - urine is still produced and lots of pelvicalyceal dilatation is seen

Question 11

What are the complications of hydronephrosis?

Answer 11

• pyelonephritis due to stasis

- marked cortical thinning/atrophy/fibrosis