RENAL PATHOLOGY 3 Flashcards
Urinary tract infections can spread through the kidney either ?
hematogenously by the blood stream or by ascending infection from the urethra or bladder
Hematogenous spread of UTIs is more common in instances of
IE
Acute pyelonephritis is most commonly caused by (1) and consist of collections of (2) within the kidney (3)
- ascending acute cystitis or urethritis 2. neutrophils (micro or macroabcesses) 3. collecting system or the interstitium surrounding the renal tubules
Where do micro or macroabcesses occur in acute pyelonephritis?
kidney collecting system or the interstitium surrounding the renal tubules
Acute pyelonephritis most commonly occurs after?
VESICOURETHRAL REFLUX-obstruction of the urinary tract or after catheterization or other instrumentation of the bladder, urethra, or ureters.
(1) can cause urinary tract infections as well as acute pyelonephritis.
- STONE, Pregnancy, BPH
Because the ureters are generally closed during micturition (urination), there should be little reflux into the ureters unless there is some sort of malformation such as (1). These individuals most likely develop reflux, and will thus transmit bacteria from bladder or urethral infections directly to the kidney
- REC. STONE
Clinically, patients can present with the distal signs of upper urinary tract infection (1), constitutional signs of infection (2), and signs of the renal infection including (3)
- dysuria, frequency, anemia 2. fever and malaise 3. posterior costovertebral angle flank pain (known as CVA tenderness).
Urinalysis for a urinary tract infection has (1)
- white blood cells in urine (pyuria) and bacteriuria.
Why are UTIs more common in women than men?
Urinary tract infections tend to be more common in women than men because estrogen increases adherence of bacteria to transitional cells, women have shorter urethras, and women lack the antibacterial prostatic secretions of men
When the infection ascends to the kidney and becomes pyelonephritis, there are (1) because the (2) in the kidney are present in the (3) and move downstream into the urine. So the classical diagnostic feature for acute pyelonephritis is (1).
- white blood cell casts 2. neutrophils 3. interstitium and tubules
Urinary tract infections generally do not progress to acute pyelonephritis and are generally confined to the urethra and bladder because of the defense against (1) from the bladder into the ureter
- reflux
Because acute pyelonephritis consists of (1) within the kidney (2), there are a number of acute complications which can arise, including (3), in which the renal papillae become necrotic and can be sloughed into the ureter causing (4)
- neutrophils 2. collecting system and interstitium 3. papillary necrosis 4. obstruction
Papillary necrosis is more common in (1)
- diabetes
PAPILLARY NECROSIS=Grossly, there is (1) and degeneration of the renal papillae while (2) and (3) are seen IN URINE.
- yellowish necrosis 2. coagulative necrosis 3. hematuria
Generally, an abscess (which is a collection of (1) develops a (2) wall as a result of the inflammation process, which stops the spread of the inflammatory process, but can make it difficult to (3)
- neutrophils 2. fibrous 3. treat with antibiotics
Chronic pyelonephritis is generally believed to be the result of multiple recurrent (1) infections which lead to fibrosis (scaring) of the (2)
- ascending 2. renal cortex
This results in an abnormal large bumpy kidney shape inside the usual rounded border.
Chronic obstructive pyelonephritis
Microscopically, in chronic pyelonephritis, the tubules are (1), or they have (2). This makes the kidney look like (3) microscopically so it is called (4).
- dilated and atrophic 2. eosinophilic hyaline casts 3. thyroid 4. thyroidization.
Microscopically, in chronic pyelonephritis, the interstititum is usually (1) with an infiltrate of (2) which represent the chronic inflammatory cells.
- fibrotic 2. lymphocytes
One uncommon type of renal infection is (1) which usually presents as a unilateral yellow tumor mass
- xanthogranulomatous pyelonephritis
The mass in xanthogranulomatous pyelonephritis consists of (1) and are most commonly a response to (2)
- lipid filled macrophages 2. proteus infection
In xanthogranulomatous pyelonephritis, (1) can be present, which are composed of (2)
- staghorn calculi 2. magnesium ammonium phosphate stones
Causes of UTIs and Pyelonephritis:
Escherichia coli, followed by Proteus, Klebsiella, and Enterobacter
Acute pyelonephritis Pus which are _____ are found where
neutrophils in collecting tubules and interstitial tissue
Predisposing factors for acute pyelonephritis:
- Urinary tract obstruction
- Congenital e.g._____
- Acquired e.g. _____
posterior urethral valves in males neonate;
prostatic hypertrophy
- Vesicoureteral reflux (VUR)
- Pregnancy (UTI and bacteriuria).
- CATHETERIZATION
- Diabetes mellitus
Immunosuppression and immunodeficiency
Predisposing factors for acute pyelonephritis
Systemic signs seen in 1); NOT seen in 2)
1) Pyelonephritis;
2) cystitis
Cystitis distinguishable from pure urethritis by more ___ onset, more ___, pain and tenderness in ____region.
acute; severe symptoms; suprapubic
septic shock
e.coli infection
Complications of acute pyelonephritis
- Papillary necrosis
- Perinephric abscess
- Healing
Complications of acute pyelonephritis
Healing: neutrophils replaced by lymphs then irregular scars that can be seen on the cortical surface as ___
fibrous depressions
Abnormal shape, large scar with loss of cortex-KIDNEY
Chronic reflux associated Pyelonephritis
•Tubules have eosinophilic hyaline casts –> thyroidization.
chronic pyelonephritis
chronic pyelonephritis histo:
- ___ dilation, atrophy and loss of glomeruli.
- Tubules have _____ –> thyroidization.
Interstitium is scarred w/ chronic inflammatory cell infiltrate.
Tubular; eosinophilic hyaline casts
Xanthogranulomatous Pyelonephritis
Inflammatory is ___
May cause ___
lipid-filled macrophages; fistulas
ca cervix
hydronephrosis
dilated pelvis, dilated cayclycial system
hydronephrosis
unilateral- dilated pelvis, dilated cayclycial system
stone, tcc
risk factors- of chronic pyelonephritis
vesicourethral reflux, a source of infection
Sickle cell anemia
Analgesic
Pyelonephritis with DM
These could produce_________
Acute papillary necrosis
