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Renal II Exam 2 > Robbins - Pyelonephritis and UTI > Flashcards

Robbins - Pyelonephritis and UTI Flashcards

1
Q

What is pyelonephritis and what structures does it affect?

A

inflammation affecting the tubules, interstitium, renal pelvis

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2
Q

What is the difference between acute and chronic pyelonephritis?

A

acute = bacterial infection

chronic = bacterial infection + other factors that predispose towards repeat acute infections

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3
Q

What organisms cause UTIs?

A

>85% caused by gram negative GI dwellers/fecal flora

Common bugs:

E. coli, Proteus, Klebsiella, Enterobacter

Fungal, viral and other bacterial cause problems too

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4
Q

How do microorganisms reach the kidneys?

A
  1. hematogenous spread from sepsis or distant infections

2 Ascending UTI or cystitis

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5
Q

What are the steps in an ascending infection causing pyelonephritis?

A
  1. colonization of distal urethra and introitus - adhesin and P-fimbrae interaction
  2. Urethra to bladder - catheters, lack of endogenous defenses
  3. Urinary tract obstruction and stasis of urine - residual urine
  4. Vesicouretal reflux - incompetent valve, congenital or bladder atony from spinal cord injury
  5. Intrarenal reflux - pulls urine into parenchyma/pyramids, esp at poles
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6
Q

What are the clinical features of acute pyelonephritis?

A

UT obstruction

Instrumentization/catheterization of urinary tract

Vesicoureteral reflex

Pregnancy - higher risk

gender and age - higher risk

Preexisting renal lesions

DM

Immunosuppression, immunodeficiency

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7
Q

What is the clinical picture of acute pyelonephritis?

A

Sudden onset of pain at CVA

systemic evidence of infection - fever, malaise

dysuria, increased frequency and urgency

urine has leukocytes/pyuria, but doesn’t differentiate between upper and lower UTI

leukocyte/pus casts = renal involvement

Use quantitative urine culture to Dx infection

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8
Q

What is the prognosis of acute pyelonephritis?

A

Benign, usu disappears aft a few days AB therapy

Bacteruria may persist for years with chronic pyelonephritis

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9
Q

What conditions make acute pyelonephritis more serious?

A

Unrelieved urinary obstruction

DM

immunodeficiency

Can lead to repeat septicemic episodes

combined with papillary necrosis can lead to renal failure

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10
Q

What virus can lead to interesting histological findings, and impacts kidney transplants?

A

polyomavirus

Reactivation in allograft immunosuppressed recipient can lead to nephropathy and rejection

Infects tubular epithelial cell nuclei

  • nuclear enlargement and inclusions with LM
  • inclusions have crystal lattics in EM
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11
Q

What is chronic pyelonephritis?

A

chronic tubulointerstitial inflammation and scarring involve calyces and pelvis

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12
Q

What conditions affect the renal calyces?

A

chronic pyelonephritis

analgesic nephropathy

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13
Q

What are the 2 forms of chronic pyelonephritis?

A

reflux nephropathy

chronic obstructive pyelonephritis

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14
Q

What is reflux nephropathy?

A

starts in childhood

UTI on top of congenital vesicoureteral reflux and intrarenal reflux

Reflux leads to scarring and atrophy, leading to renal insufficiency

  • can be b/l or u/l

Vesicoureteral reflux can also cause problems in absence of infection - sterile reflux

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15
Q

What is chronic obstructive pyelonephritis?

A

recurrent infections on top of diffuse or localized obstructive leasions leads to renal inflammation and scarring

Leads to parenchymal atrophy and renal insufficiency

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16
Q

What are the morphological hallmarks of acute pyelonephritis?

A

Patchy interstitial suppurative inflammation

intratubular aggregates of neutrophils, neutrophilic tubulitis

tubular necrosis

  • focal or wedge-sheped necrosis
17
Q

How does the bacterial infection spread throughout the kidney with acute pyelonephritis?

A

Propelled into renal parenchyma with intrarenal/vesicoureteral reflux

collecting tubules –> tubular lumens –> interstitium –> abscess formation –>

tubules destroyed

(glomeruli usually spared)

18
Q

What are 3 important complications associated with acute pyelonephritis?

A

Papillary necrosis

Pyenephrosis

Perinephric abscess

19
Q

What would you see, histologically, with papillary necrosis? What diseases is it associated with?

A

Seen with DM, sickle cell disease, or urinary tract obstruction

u/l or b/l

pyramids have gray/white/yellow necrosis

  • histologically -> ischemic coag necrosis, tubule outlines preserved
20
Q

What happens in pyonephrosis?

A

Acute pyelonephrosis with total/almost complete obstruction high in urinary tract

Pus is unable to drain and fills renal pelvis, calyces, and ureter

21
Q

What is perinephric abscess?

A

Acute pyelonephritis that has dissected through renal capsule into perinephric tissue

22
Q

What clues does acute pyelonephritis leave behind after the infection has cleared?

A

Pus replaced with MOs, plasma cells, lymphocytes

Inflammatory foci replaced with scarring

Pyelonephric scar associated with inflammation, fibrosis, and deformation of the underlying calyx and pelvis

23
Q

What are the morphological hallmarks of chronic pyelonephritis?

A

coarse, discrete corticomedullary scars overlying dilated, blunted, or deformed calyces and flattening of the papillae

  • scars often in upper or lower poles

Dilated tubules with thyroidization/protein casts

Vessels have intimal thickening in scarred areas

HTN will cause arteriosclerosis, glomerular changes

24
Q

What is xanthogranulomatous pyelonephritis?

A

Rare form of chronic pyelonephritis

  • accum. of foamy MOs with plasma cells, lymphocytes, PMNs, giant cells
  • assoc. with Proteus infections and obstruction
  • lesions with large, yellowish orange nodules that look like renal cell carcinomas
25
Q

What is the initial clinical presentation of chronic pyelonephritis?

A

back pain, fever, pyuria, bacteriuria

  • gradual onset of renal insufficiency and HTN

Loss of tubular fxn - conc abililty - polyuria and nocturia

26
Q

What are some important long-term sequelae associated with chronic pyelonephritis?

A

Some people can develop FSGS with significant proteinuria - bad sign

  • several years aft scarring has occurred
  • can progress to ESRD

Glomerulosclerosis is result of glomerular adaptations to loss of renal mass due to scarring. (renal ablation nephropathy)

Renal II Exam 2 (8 decks)

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