Pyelonephritis/hydronephrosis Flashcards
(11 cards)
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?
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
What are the 3 different pathogeneses for pyelonephritis?
- Blood borne in septicaemia
- Post-surgery
- Ascending infection
What 7 risk factors exist for pyelonephritis?
- Age and sex
- pregnancy
- instrumentation
- obstruction of urinary tract (prostate, urethra, calculi, stricture, tumour)
- vesico-ureteric reflux (congenital or acquired)
- diabetes
Chronic pyelonephritis:
- is there usually a previous history of UTI?
- what are the two clinical features?
- what is seen on imaging kidney?
-usually no previous history UTI
Clinical features: high BP +/- uraemia, large volume of urine
Imaging: course cortical scarring, distorted calyces, shrunken kidney
Tuberculosis PN:
- what is the pathogenesis?
- symptoms 4
- signs
- diagnosis
-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)
What is cystitis? what are the causal organisms? what are the features of cystitis?
Cystitis: bladder infection
-e.coli, klebsiella, proteus, pseudomonas
Features: acute inflammation but can become necrotising if assoc. outlet obstruction
What is ureteritis and cystitis cystica?
Cysts in ureter/cysts in bladder
- multiple fluid filled cysts projecting into lumen
- can resemble tumours
Schistosomiasis: what does this increase the risk of?
- tropical countries
- increased risk of squamous cell carcinoma bladder
Hydronephrosis:
- what is this?
- features?
- causes if bilateral 4
- causes if unilateral 4
=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
If the obstruction is sudden and complete, how does this differ from if the obstruction was partial and gradual?
Sudden and complete - little pelvicalyceal dilatation and no urine production
Partial and gradual - urine is still produced and lots of pelvicalyceal dilatation is seen
What are the complications of hydronephrosis?
- pyelonephritis due to stasis
- marked cortical thinning/atrophy/fibrosis