RENAL PATHOLOGY 3

Question 1

Urinary tract infections can spread through the kidney either ?

Answer 1

hematogenously by the blood stream or by ascending infection from the urethra or bladder

Question 2

Hematogenous spread of UTIs is more common in instances of

Answer 2

IE

Question 3

Acute pyelonephritis is most commonly caused by (1) and consist of collections of (2) within the kidney (3)

Answer 3

1. ascending acute cystitis or urethritis 2. neutrophils (micro or macroabcesses) 3. collecting system or the interstitium surrounding the renal tubules

Question 4

Where do micro or macroabcesses occur in acute pyelonephritis?

Answer 4

kidney collecting system or the interstitium surrounding the renal tubules

Question 5

Acute pyelonephritis most commonly occurs after?

Answer 5

VESICOURETHRAL REFLUX-obstruction of the urinary tract or after catheterization or other instrumentation of the bladder, urethra, or ureters.

Question 6

(1) can cause urinary tract infections as well as acute pyelonephritis.

Answer 6

1. STONE, Pregnancy, BPH

Question 7

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

Answer 7

1. REC. STONE

Question 8

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)

Answer 8

1. dysuria, frequency, anemia 2. fever and malaise 3. posterior costovertebral angle flank pain (known as CVA tenderness).

Question 9

Urinalysis for a urinary tract infection has (1)

Answer 9

1. white blood cells in urine (pyuria) and bacteriuria.

Question 10

Why are UTIs more common in women than men?

Answer 10

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

Question 11

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).

Answer 11

1. white blood cell casts 2. neutrophils 3. interstitium and tubules

Question 12

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

Answer 12

1. reflux

Question 13

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)

Answer 13

1. neutrophils 2. collecting system and interstitium 3. papillary necrosis 4. obstruction

Question 14

Papillary necrosis is more common in (1)

Answer 14

1. diabetes

Question 15

PAPILLARY NECROSIS=Grossly, there is (1) and degeneration of the renal papillae while (2) and (3) are seen IN URINE.

Answer 15

1. yellowish necrosis 2. coagulative necrosis 3. hematuria

Question 16

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)

Answer 16

1. neutrophils 2. fibrous 3. treat with antibiotics

Question 17

Chronic pyelonephritis is generally believed to be the result of multiple recurrent (1) infections which lead to fibrosis (scaring) of the (2)

Answer 17

1. ascending 2. renal cortex

Question 18

This results in an abnormal large bumpy kidney shape inside the usual rounded border.

Answer 18

Chronic obstructive pyelonephritis

Question 19

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).

Answer 19

1. dilated and atrophic 2. eosinophilic hyaline casts 3. thyroid 4. thyroidization.

Question 20

Microscopically, in chronic pyelonephritis, the interstititum is usually (1) with an infiltrate of (2) which represent the chronic inflammatory cells.

Answer 20

1. fibrotic 2. lymphocytes

Question 21

One uncommon type of renal infection is (1) which usually presents as a unilateral yellow tumor mass

Answer 21

1. xanthogranulomatous pyelonephritis

Question 22

The mass in xanthogranulomatous pyelonephritis consists of (1) and are most commonly a response to (2)

Answer 22

1. lipid filled macrophages 2. proteus infection

Question 23

In xanthogranulomatous pyelonephritis, (1) can be present, which are composed of (2)

Answer 23

1. staghorn calculi 2. magnesium ammonium phosphate stones

Question 24

Causes of UTIs and Pyelonephritis:

Answer 24

Escherichia coli, followed by Proteus, Klebsiella, and Enterobacter

Question 25

Acute pyelonephritis Pus which are _____ are found where

Answer 25

neutrophils in collecting tubules and interstitial tissue

Question 26

Predisposing factors for acute pyelonephritis:

• Urinary tract obstruction
• Congenital e.g._____
• Acquired e.g. _____

Answer 26

posterior urethral valves in males neonate;

prostatic hypertrophy

Question 27

• Vesicoureteral reflux (VUR)
• Pregnancy (UTI and bacteriuria).
• CATHETERIZATION
• Diabetes mellitus

Immunosuppression and immunodeficiency

Answer 27

Predisposing factors for acute pyelonephritis

Question 28

Systemic signs seen in 1); NOT seen in 2)

Answer 28

1) Pyelonephritis;
2) cystitis

Question 29

Cystitis distinguishable from pure urethritis by more ___ onset, more ___, pain and tenderness in ____region.

Answer 29

acute; severe symptoms; suprapubic

Question 30

septic shock

Answer 30

e.coli infection

Question 31

Complications of acute pyelonephritis

Answer 31

1. Papillary necrosis
2. Perinephric abscess
3. Healing

Question 32

Complications of acute pyelonephritis

Healing: neutrophils replaced by lymphs then irregular scars that can be seen on the cortical surface as ___

Answer 32

fibrous depressions

Question 33

Abnormal shape, large scar with loss of cortex-KIDNEY

Answer 33

Chronic reflux associated Pyelonephritis

Question 34

•Tubules have eosinophilic hyaline casts –> thyroidization.

Answer 34

chronic pyelonephritis

Question 35

chronic pyelonephritis histo:

• ___ dilation, atrophy and loss of glomeruli.
• Tubules have _____ –> thyroidization.

Interstitium is scarred w/ chronic inflammatory cell infiltrate.

Answer 35

Tubular; eosinophilic hyaline casts

Question 36

Xanthogranulomatous Pyelonephritis

Inflammatory is ___

May cause ___

Answer 36

lipid-filled macrophages; fistulas