Case 2 - UTI
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Pyelonephritis
o
Ascending urinary tract infection
Reaches Pyelum of kidney
o
Dividing into: A) Acute Pyelonephritis B) Chronic Pyelonephritis
Acute pyelonephritis (APN)
Epidemiology:i.
More common in women than men
o
Women have a short urethra
Risk Factors:i.
Urinary Tract Obstructionii.
Medularry Sponge kidneyiii.
Diabetes mellitusiv.
Preganancyv.
Sickle cell trait/disease
Pathogenesis:i.
Vesicoureteral reflux (VUR) with ascending infection
o
Intravesical portion of the ureter is normallycompressed with micturition
Prevents reflux of urine into the uterus
o
In VUR, the intravesical portion of the ureter is notcompressed during micturition
Urine refluxes into the uretersii.
Ascending Infection:
o
Most common mechanism for UTI in females
o
Distal urethra and vaginal introitus are normallycolonised by E. Coli
o
Oragnisms ascend into urethra and bladder
Causes urethritis and cystitis
o
If VUR is present, infected urine ascends to the renalpelvis and renal parenchyma
Causes APN
Case 2 - UTI
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Gross and microscopic findings:i.
Greyish white areas of abscess formation are in the cortex +medullaii.
Microabscess formation occurs in the tubular lumens andintersstitium (Shown below)
Clinical Findings:i.
Spiking fever, flank painii.
Increased frequency of urinationiii.
Painful urination (dysuria)
Laboratory findings:i.
WBC casts
(key fidning
)ii.
Pyuriaiii.
Bacteriuria (usually E. Coli)iv.
Haematuria
Complications:i.
Chronic pyelonephritisii.
Perinephric abscessiii.
Renal Paillary necrosisiv.
Septicemia with endotoxic shock
Case 2 - UTI
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Chronic Pyelonephritis (CPN)
Pathogensis:i.
VUR starting in young girlsii.
Lower urinary tract obstruction
o
Produces hydronephrosis
o
Example:
Prostatic hyperplasia
Renal stones
Gross and microscopic findings:i.
Reflux type of CPN
o
U-shaped cortical scars
overlying a blunt calyx
o
Visible with
an intravenous pyelogram (IVP)ii.
Obstruction type CPN
o
Uniform dilation of the calyces
o
Diffuse thinning of cortical tissuesiii.
Microscopic findings
o
Chronic inflammation
Secondary scarring of the glomeruli
o
Tubular atrophy
Tubules contain:
Eosinophilic material
o
Resemble thyroid tissue
„‟Thyroidization‟‟
Clinical and laboratory findings
Note here the changes we call"thyroidization." You will see manychronic inflammatory cells in theinterstitial tissue and dilated tubulescontaining pink staining proteinaceousgoo, giving the appearance of thyroidcolloid. You should note the scarring inthe interstitial tissue in general and tosome degree around the glomeruli.This is often associated with chronicischemic injury of the kidney, whichworsens as the process proceeds.Think diabetes and hypertension.Reference:http://medsci.indiana.edu/c602web/602/c602web/renal/slide79.htm
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