Downloaded 17 times
More Related Content
Similar to acute pyelonephritis ab. d
acute pyelonephritis ab. d
- 1.
- 2. Kidney Diseases • Glomerulardiseases • Vascular diseases • Tubular and interstitial diseases # Acute tubular injury # pyelonephritis and UTI - Acute Pyelonephritis - Chronic pyelonephritis • Urinary tract obstruction # Hydronephrosis
- 3. Objectives • Acute pyelonephritis -Pathogenesis, - Morphology • Hydronephrosis - Pathogenesis - Morphology
- 4. Sudden pain at Costovertebralangle fever Dysuria, frequency & urgency Leukocytes in urine Patient with
- 5. Acute pyelonephritis • Itis a suppurative inflammation of the kidney caused by bacterial (and sometimes viral) infection. Associated with • UTI • Vesicoureteral reflex • Preexisting renal lesions • DM (neurogenic bladder dysfunction) • Immunosuppression (polyomavirus) Common agents E. Coli Proteus Klebseilla Enterobacter Fungal organism
- 6. Morphology Hallmarks of acutepyelonephritis • Patchy interstitial suppurative inflammation • Intratubular aggregates of neutrophils • Neutrophilic tubulitis and tubular necrosis
- 7. Morphology # Complication ofacute pyelonephritis 1. papillary necrosis Gross : gray white to yellow necrosis in tip (2/3rd) of pyramids
- 8. Fig.Arrow showing smallyellowish micro abscesses involving cortex and medulla
- 9. Microscopic : - characteristiccoagulative necrosis with tubules outline preservation - leukocytes response (junction between preserve and destroyed tissue)
- 10. 2. pyonephrosis - seenin almost complete obstruction Suppurative exudate – unable to drain – fill the renal pelvis, calyces, and ureter with pus 3. perinephric abscess - extension of suppurative inflammation through renal pelvis into perinephric tissue
- 11. After acute phaseof pyelonephritis Healing process start • neutrophilic infiltrate replaced by – macrophages, plasma cells and lymphocytes • Inflammatory foci replaced by – irregular scars/cortical surface as fibrous - depression. tubular atrophy, interstitial fibrosis and lymphatic infiltration
- 12.
- 13. Hydronephrosis is thedilation of renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction to the outflow
- 14. Common causes • Congenitalanomalies-meatal stenosis • Urinary calculi • Benign Prostatic Hypertrophy • Tumors : carcinoma of prostate, bladder • Inflmmation –prostatitis,urethritis • Uterine prolapse and cystocele •
- 15. Unilateral or bilateralobstruction Increased wall pressure in urinary tract Dilatation of pelvis and calyces Compression of renal vasculature of medulla and venous stasis Pathogenesis
- 16. Impaired concentration abilityat initial stage Finally GFR decreases Renal failure and uremia # Obstruction triggers Interstitial inflammatory reactions Interstitial fibrosis
- 17. Morphology • Obstruction –sudden and complete : mild dilation of pelvis & calyces sometimes renal parenchymal arophy - subtotal &intermittent : progressive dilation causing hydronephrosis • Kidney – massive and slightly enlarged - interstitial inflammation
- 18. • In Chroniccase - cortical tubular atrophy with diffuse interstitial fibrosis - progressive blunting of apices of pyramids (cup shaped) • In far advanced case – - kidney transformed into thin walled cystic structure with parenchymal atrophy, total obliteration of pyramids , & thinning of cortex
- 19. Fig. hydronephrosis Pelvis andcalyces dilation and thinning of renal parenchyma
- 20. Clinical features 1. unilateralcomplete or partial hydronephrosis - silent for long period - Diagnosed by USG 2. Bilateral partial obstruction - inability to concentrate urine (earliest manifestation)- polyuria, nocturia - distal tubular acidosis , renal salt wasting, secondary renal calculi - Scarring and atrophy of papilla & medulla 3. Complete bilateral obstruction - Oliguria or anuria - Life threatening
- 21. References • Robbins andCotran Pathologic basis of disease,9e,vol2 • Robbins and Cotran atlas of pathology, 3e
- 22.